Applicant Certification. Per Harbors and Navigation Code 525 (C) “A grant awarded by the department pursuant to subparagraph (A) shall be matched by a 10% contribution from the local agency receiving the grant.” Matching fund may be rendered in cash, or through in-kind contributions which must be verified, and are at the discretion of DBW. These contributions may include (but are not limited to) the following: administrative costs, personnel hours, removal, and/or storage. Xxxxx monies WILL NOT be reimbursed by DBW unless 10% match for each reimbursement claim is met.
a. Under penalty of xxxxxxx, I certify that I have examined this application and the document(s), proposal(s), and statement(s) submitted in conjunction herewith, and that to the best of my information and belief, the information contained herein is true, accurate, correct, and complete.
b. I certify that I am the person authorized to submit this application on behalf of the applicant.
Applicant Certification. I hereby certify and affirm that the above information, along with any additional forms, supplements, and attachments are true and correct. I understand that providing untrue or false statements in this Application/Agreement may result in the immediate denial or revocation of any authorization to use any Wakulla County Facilities. I further certify and affirm that I have reviewed all of the attached Facility Use Agreement Terms and Conditions, Chapter 23 of the Wakulla County Code of Ordinances and agree to be bound by all such provisions. I understand that the Facility Use Agreement shall not be effective and approved until execution by an authorized representative of Wakulla County. Date: Approved by:
Applicant Certification. As the duly designated certifying official of the recipient, I also certify that: I am authorized to and do consent to assume the status of responsible federal official under the National Environmental Policy Act of 1969 and each provision of law designated in the 24 CFR 58. Signature of the Certifying Officer of Applicant Date Print Name and Title of Certifying Officer of Applicant Appendix D AUTHORIZATION FOR ALTERNATE SIGNATORIES FOR SECTION 106 COMPLIANCE FORMS CDBG Grant Administrators or City Clerks may now sign the Section 106 Compliance Forms including the Exempt from Review Project Determination Form and the Request for Comment on a HUD Project form. In order to take advantage of this opportunity, the Agency Official/CEO must sign this form before a notary public. The CEO is the person who signed the CDBG contract. The grant administrator or City Clerk must also sign this form as a signatory. Note: By signing this agreement, the Agency Official/CEO is still legally responsible for all findings and determinations made on their behalf by the signatory. Once signed, submit this form with your Section 106 compliance documentation. As stated in 36 CFR Part 800, the implementing regulation for Section 106 of the National Historic Preservation Act of 1966, the Agency Official with jurisdiction over an undertaking takes legal and financial responsibility for Section 106 compliance in accordance with Subpart B of 36 CFR Part 800. In the case of the state Community Development Block Grant (CDBG) Program, however, the Agency Official will be the selected non-entitlement cities, which as CDBG recipients are authorized to serve as the Agency Official under 24 CFR Part 58. In the event that the Agency Official is unable to sign the Request for Comment form or the Exempt from Review Project Determination From, however, the following alternates signatories listed below are authorized to act on the behalf of the Agency Official. In the event an alternate signatory is used, the Agency Official remains legally responsible for all required findings and determinations made through the Section 106 process. The signatures attested below are effective as of: (Date) Sincerely, Agency Official (CEO) signature [Name and Title of] Signatory # 1 Signature of Signatory #1 [Name and Title of] Signatory # 2 Signature of Signatory #2 [Name and Title of] Witness Signature of Witness
Applicant Certification. The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all applicable requirements of 10 C.F.R. § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE). DOE F 1600.5 OMB Control No. (00-00) 0000-0000 All Other Editions Are Obsolete Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Information Resources Management Policy, Plans, and Oversight, Records Management Division, HR-422-GTN, Paperwork Reduction Project (1910-0400), U.S. Department of Energy, 0000 Xxxxxxxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, XX 00000; and to the Office of Management and Budget (OMB), Paperwork Reduction Project (1910-0400), Xxxxxxxxxx, XX 00000. (Enter name of Borrower’s Subcontractor) (hereinafter called the "Applicant") HEREBY AGREES to comply with Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), Section 16 of the Federal Energy Administration Act of 1974 (Pub. L. 93-275), Section 401 of the Energy Reorganization Act of 1974 (Pub. L. 93-438), Title IX of the Education Amendments of 1972, as amended (Pub. L. 92-318, Pub. L. 93-568, and Pub. L. 94-482), Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), the Age Discrimination Act of 1975 (Pub. L. 94-135), Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-284), the Department of Energy Organization Act of 1977 (Pub. L. 95-91), the Energy Conservation and Production Act of 1976, as amended, (Pub. L. 94-385) and Title 10, Code of Federal Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant agrees to assure that no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity in which the Applicant receives Federal assistance from the Department of Energy.
Applicant Certification. The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all applicable requirements of 10 C.F.R. §1040.5 (a copy will be furnished to the Applicant upon written request to DOE). Name: Title: Telephone Signature Date: Subcontractor Name: Telephone: Address: Name: Title: Telephone Signature Date:
Applicant Certification. I do not have any unanswered questions regarding voluntary exclusion that I believe prevents me from making an informed decision about whether to complete and sign this Application and Agreement. Initial
Applicant Certification. I agree to comply with the guidelines and standards of the City of Hillsboro Facade Improvement Program and I understand that this is a voluntary program, under which the City has the right to approve or deny any project or proposal or portions thereof in its full discretion. Applicant(s) Signature Date Building Owner’s Signature Date (if separate from applicant)
Applicant Certification. The Employer and the Union are committed to improving the quality of service and professionalism in the parking industry. In order to further this goal, the parties have agreed to establish a basic certification process for applicants. Applicants will be referred to the Local 665 office where they will be introduced to the industry, Union membership and offered a voluntary certification exam (exam). The exam, covering integrity, honesty and basic job skills, will be offered to the applicant by the Union. The exam will be drafted and scored by a third party testing firm on a pass/no pass basis. If the applicant passes the exam, he/she will be considered certified" and awarded a certificate. Employers seeking new hires will view "certified" applicants positively.
Applicant Certification. The form,
Applicant Certification. I, , hereby authorize the Town of North Stonington to share my application and reporting requirements with the Economic Development Commission for the purpose of providing underwriting and administrative services for the program/request. I agree that any funds provided pursuant to this application will be utilized exclusively for the purpose(s) set forth in this application, the program guidelines, the Economic Development Commission’s approval, and conditions, and shall not be used for any excluded use pursuant to applicable Federal, State or Local program guidelines. That the business expenses for which I have requested a grant under the North Stonington COVID-19 Small Business Assistance Program are for a different purpose that that for which assistance was provided under the EIDL or PPP and does not constitute a duplication of benefits. Finally, I swear that the statements made on this application are true and complete. I understand that false or misleading statements may result in forfeiture of benefits and criminal prosecution under the laws of the State of Connecticut. Applicant Signature: Printed Name: Date: This affidavit being dully signed before me: Notary Public or Date Commissioner of Superior Court
