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EXHIBIT A. CORONAVIRUS STATE FISCAL RECOVERY FUND ACCEPTANCE CERTIFICATION

AR ADC 006.09.4 Exh. AArkansas Administrative CodeEffective: May 5, 2022

West's Arkansas Administrative Code
Title 006. Department of Finance and Administration
Division 09. Office of Accounting
Rule 4. Method of Distribution of American Rescue Plan Act Funds for Covid-19 Testing
Effective: May 5, 2022
Ark. Admin. Code 006.09.4 Exh. A
EXHIBIT A. CORONAVIRUS STATE FISCAL RECOVERY FUND ACCEPTANCE CERTIFICATION
I, _____________________________________________, certify that I am the Chief Executive Officer, or equivalent officer, (Chief Executive) of ________________________________________ located in ______________________________, Arkansas (Subrecipient) and, on behalf of the Subrecipient, I hereby certify, represent, warrant and agree that:
1. I have the authority to bind the Subrecipient by this certification and to make each Coronavirus State Fiscal Recovery Fund (“SFRF”) Request seeking direct payment and/or reimbursement whether now or hereafter requested from the COVID-19 Testing Program created by the State of Arkansas and managed by the Arkansas Department of Finance and Administration (“Department”); and
2. All SFRF Program funds (and each SFRF Request) are subject to section 602 of the Social Security Act, as added by Section 9901 of the American Rescue Plan Act of 2021, Pub. L. No. 117-2 (ARPA Act); and
3. The State of Arkansas and the Department are authorized to rely upon this certification as a material representation made by the Subrecipient (and by me, as the Chief Executive Officer, or equivalent officer, of the Subrecipient) in connection with each SFRF Request; and
4. Each SFRF Request meets the COVID-19 Testing Program qualifications and requirements including the following:
a. All payment and reimbursement requests only qualify if: (i) such request is for funds to cover the cost of COVID-19 testing for an employee who is subject to an employer-required or employer-mandated COVID-19 vaccination or immunization, whose health benefit plan does not cover the cost of COVID-19 testing, and who wishes to continue employment by claiming an exemption under one of the options of the specific exemption process provided for by Ark. Code Ann. § 11-5-118 (Act 1115 of the 2021 Regular Session, 93rd General Assembly); and (ii) such cost having been incurred during the period that begins January 14, 2022 and ends on July 31, 2023; and
b. Each SFRF Request is submitted with appropriate documentation; and
5. Failure of any SFRF Request or any use of SFRF Funds to meet any COVID-19 Testing Program qualifications and requirements, or if there is any misrepresentation made by the Subrecipient related to this certification, shall require, upon any request of the Department, that the Subrecipient repay to the State of Arkansas the related COVID-19 Testing Program funds.
I certify under the penalties of perjury that I have read the above certification and my statements contained herein are true and correct to the best of my knowledge.
[Print Participant Name here]
By: __________________________________________________
Signature: _____________________________________________
Title: __________________________________________________
Date: __________________________________________________
STATE OF ARKANSAS
)
)
SS:
COUNTY OF __________
)
Before me, a Notary Public in and for said County and State, personally appeared ______________________________, known to me to be the Chief Executive Officer or equivalent officer of ___________________________________, and I acknowledge the execution of the foregoing.
Witness my hand and Notarial Seal this ___ day of __________, 202__.
________________________________________
My Commission Expires:
Notary Public Residing in ____________________
County, Arkansas
________________________________________
____________________
(Printed Signature)
BEFORE SUBRECIPIENT RECEIVES ANY SFRF FUNDS, THIS FULLY EXECUTED AND NOTARIZED CORONAVIRUS STATE FISCAL RECOVERY FUND ACCEPTANCE CERTIFICATION MUST BE E-MAILED AND SENT VIA U.S. MAIL TO THE FOLLOWING ADDRESSES:
Email Address: [email protected]
U.S. Mail: Arkansas Department of Finance and Administration
P.O. Box 3278
Little Rock, AR 72203-3278

Credits

Adopted emergency effective Jan. 14, 2022. Amended May 5, 2022.
Current with amendments received through January 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 006.09.4 Exh. A, AR ADC 006.09.4 Exh. A
End of Document