Annex B.
4 - Notarized MLGU Certification of Compliance for Fund Release
(Potable for Drinking _ not in Hazard Area _ no Website)
FY 2020 LGSF-SALINTUBIG
Republic of the Philippines
Province of Cagayan
MUNICIPALITY OF LAL-LO
Office of the
Mayor
CERTIFICATION
In the implementation of amounting to
PhP_______________ in the Municipality of Lal-lo under the FY 2020 Local Government
Support Fund-Provision of Potable Water Supply (LGSF-SALINTUBIG) Program, we hereby
attest that:
1. Detailed Engineering Design (DED) has been prepared in accordance with Annex “A” of
2016 Revised IRR of R.A. 9184 (Detailed Engineering for the Procurement of Infrastructure
Project), National Government standards, and relevant provisions of the General
Appropriations Act (GAA) and other applicable laws and issuances;
2. The water source has been validated by the Municipal Engineer and has found to be feasible
in supplying water to the intended beneficiaries and potable for drinking.
3. Our Municipal Local Government Unit (MLGU) has an established PIT, PMC, and
Inspectorate Team based on the attached Executive Orders issued by the undersigned.
4. Certified True Copies of the following documents are hereby attached:
4.1. Approved Detailed Engineering Design (DED);
4.2. Proof of application and/or payment of the following permits:
a. Environmental Compliance Certificate (ECC) or Certificate of Non-
Coverage (CNC) from the Department of Environment and Natural Resources–
Environmental Management Bureau (DENR-EMB), whichever is applicable.
b. Certificate of Non-Overlap (CNO) or Free, Prior and Informed Consent
(FPIC) from National Commission on the Indigenous People (NCIP), whichever is
applicable.
c. Water Permit from the National Water Resources Board (NWRB);
d. Other permits as may be required by laws, rules, or other concerned agencies for
the implementation of the project.
4.3. Deed of Donation or Deed of Absolute Sale or Usufruct or any other legal
documents proving that the site of the project has no land ownership or Right-of-Way
(ROW) issues;
4.4. Water Source Validation Report (WSVR)
4.5. MGB Certification that the project is not located in the “no-build” zone and
hazard-prone area;
4.6. Executive Orders creating or activating the PIT, PMC and Inspectorate Team.
Annex B.4 - Notarized MLGU Certification of Compliance for Fund Release
(Potable for Drinking _ not in Hazard Area _ no Website)
FY 2020 LGSF-SALINTUBIG
5. The project is included in the updated and duly adopted Local Development Investment
Program (LDIP) of the Municipality and must not be funded from other sources.
6. The proposed SALINTUBIG Project/s is/are included in the approved Annual Procurement
Plan of the Municipality.
7. The bidding documents have been prepared, and to ensure that the bidding can commence
on (identify date), these documents shall be made available to DILG during field
monitoring visits and/or as may be requested.
8. Funds downloaded to our MLGU from the national subsidy of DILG-OPDS Administered
Programs from previous funding years (2012-2018) will be fully liquidated by 31 December
2020
9. Undisbursed funds from the national subsidy of DILG-OPDS Administered Programs from
previous funding years (2012-2018) have been reverted to the source agency (DILG or
Bureau of Treasury) and the Notarized Affidavit of Undertaking, when applicable, were
submitted to the DILG, pursuant to applicable provisions of the General Appropriations Act
(GAA) and all the DILG Memoranda issued for the purpose;
10. Our Municipality commits and binds itself/ourselves to comply with all the provisions of the
Project Implementation and Monitoring Guidelines issued by the DILG.
11. Funds shall be made available for the maintenance once the project is completed.
12. Our MLGU commits to established a functional and operational website within the year.
We agree that our Municipality may be ineligible to receive a subsidy from the SALINTUBIG
Program in the next Fiscal Year (FY) if any of the above attestations/declarations to be
misrepresented or false.
We agree that our Municipality is primarily and solely accountable and responsible as to the
truthfulness of these attestations, and at the same time, further attests to the accuracy and
completeness of the submitted technical documents, as well as its consistencies and conformity
to national standards.
We further agree that our Municipality will be subjected to penalties and sanctions in case of
non-compliance to Project Implementation and Monitoring Guidelines issued by the DILG.
This Certification is being issued in compliance with the DILG Memorandum Circular
No._____, Series of 2020.
ENGR. JOLSON A. MAAGAD
Municipal Planning and Development Coordinator Date
ENGR. RONALD E. MATAS
Municipal Engineer Date
Annex B.4 - Notarized MLGU Certification of Compliance for Fund Release
(Potable for Drinking _ not in Hazard Area _ no Website)
FY 2020 LGSF-SALINTUBIG
FLORENCE OLIVER B. PASCUAL
Municipal Mayor Date
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES
(Municipality/City of ________________) S.S.
Subscribed and sworn to before me on this date, a Notary Public for and in __________,
Philippines.
NOTARY PUBLIC
Doc. No. __________
Book No. __________
Page No. __________
Series of __________
