Common use of Claim Certification Form Clause in Contracts

Claim Certification Form. The Claim certification required by this Section shall provide as follows: CLAIM CERTIFICATION Under penalty of perjury, and with specific reference to the California False Claims Act, Government Code sections 12650 et seq., I certify that submission of the attached Claim is made in good faith; that the supporting data prepared by the undersigned company are accurate and complete to the best of my knowledge and belief; that submission of the Claim to District does not violate the False Claims Act; and that I am duly authorized to certify the Claim on behalf of the Claimant. Date: Company: Corporate Seal Print Name: Signature: Title:

Claim Certification Form. The Claim claim certification required by this Section 23.04 shall provide as follows: CLAIM CERTIFICATION Under penalty of perjury, and with specific reference to the California False Claims Act, Government Code sections 12650 12650, et seq., I certify that submission of the attached Claim claim is made in good faith; that the supporting data prepared by the undersigned company are accurate and complete to the best of my knowledge and belief; that submission of the Claim claim to District does not violate the False Claims Act; and that I am duly authorized to certify the Claim claim on behalf of the Claimantclaimant. DateDated: Company: Company Corporate Seal Print Name: Signature: Name Signature Title: