Local Heritage Fund - Project compliance certification
Complete this form once the project is finished
Completion of this form is a standard condition of the project Funding Agreement and must be
completed for every project before payment of grant funding from the Local heritage fund.
Who can certify?
The local government heritage planner/officer or heritage advisor or nominated project heritage
specialist consultant.
How to complete this form
The certifier must cite and review ALL relevant project scope and approval/consent documents
set out below and certify that the works have been completed in accordance with these
documents and approvals. The certifier MUST complete ALL of the following sections.
PLEASE NOTE: This project certification satisfies the Local Heritage Fund project Funding Agreement requirements
ONLY – it does not replace any local council development/building certification requirements.
Project name
Project no.
Project address
Applicant name
I certify that the works completed in the project funded by Local Heritage Fund are in
accordance with the following:
Project Scope
The project scope provided as part of the Local Heritage Fund project Funding
Agreement, or a variation/s to the project scope that has been agreed to by
Council as part of the project Funding Agreement.
Yes
or No
Project funding agreement, standard and special conditions
The Local Heritage Fund project Funding Agreement standard conditions and
special conditions dated
(insert date here)
Yes
or No
Heritage Act exemption or s60 approval
Exemption or S60 approval (where applicable) for the project granted by the
NSW Heritage Council dated
(insert date here) under the Heritage Act,
1977.
Heritage Act Exemption
Yes
or No
or N/a
Heritage Act S60
Yes
or No
or N/a
Local council development consent
Development consent (where applicable) for the project granted by the
Council dated
(insert date here) under the EP & A Act
Yes
or No
or N/a
Project cost and works completed
That the final project cost is commensurate with the works undertaken.
Yes
or No
or N/a
Certifier’s name
Signature
Type your name OR print, sign and re-scan
Position
Date
Email
Phone
Add your council logo here