Va Form 40-0895-11 - Memorandum Of Agreement For A Grant To Construct Or Modify A State Or Tribal Government Veterans Cemetery

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OMB NUMBER: 2900-0559
Respondent Burden: 2 hours
MEMORANDUM OF AGREEMENT FOR A GRANT TO CONSTRUCT
OR MODIFY A STATE OR TRIBAL GOVERNMENT VETERANS CEMETERY
This Memorandum of Agreement is hereby made by and between The Department of Veterans Affairs (VA),
810 Vermont Avenue, NW, Washington, D.C. 20420, and __________________________________________________
who has submitted to VA an application for a grant to
construct or
modify a _____________________________
(Description)
___________________________________________ facility for veterans in ____________________________________
(Description)
(Location)
______________________________________________________________.
(Location)
The Federal Application Identifier (FAI) Number for this project is ______________________. The parties agree that this
application meets the requirements of Federal Law for this grant. The estimated total cost of $__________________,
including equipment, in which VA will participate, is $ ______________. The VA grant will total up to $_____________,
but will not exceed one hundred (100) percent of the actual cost of $_______________ as determined at final audit.
In consideration of the foregoing, the parties hereby mutually agree as follows:
(1) ___________________________________ certifies that the plans and specifications included in the
application meet all applicable Federal requirements.
(2) ___________________________________ agrees that it will
construct or
acquire a
__________________________________________________________________________________, to be completed in
(Description of the project)
accordance with the documentation submitted by the State.
(3) ___________________________________ agrees to comply strictly with the assurances contained in
the documentation submitted by the state.
(4) ___________________________________ agrees to enter into a contract to
construct or
modify a _________________________________________________________________________
(Description of this project)
within 90 days of the date on which both parties have signed this agreement.
(5) ___________________________________ agrees to periodically inspect the project and certify to the
Director, State Cemetery Grants Service (41E), 810 Vermont Avenue, NW, Washington, D.C. 20420, for payment of
such sums which it deems are payable by VA.
(Continued on next page)
40-0895-11
VA FORM
OCT 2010

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