Common use of Applicant Certification Clause in Contracts

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 Appendix E 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 Appendix F

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 Applicant, Date Print Name and Title of Certifying Officer of Applicant Appendix D Appendix E 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 publicand have it witnessed. 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 Appendix FIowa Site Inventory Form State Inventory Number: New Supplemental State Historic Preservation Office 9-Digit SHPO Review & Compliance (R&C) Number: (January 2016) Non-extant Year: Read the Iowa Site Inventory Form Instructions carefully, to ensure accuracy and completeness before completing this form. The instructions are available on our website. • Property Name

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 Applicant, Date Print Name and Title of Certifying Officer of Applicant Appendix D Appendix E AUTHORIZATION FOR ALTERNATE SIGNATORIES FOR SECTION SEC TIO N 106 COMPLIANCE FORMS CDBG CO MPL XXX CE FOR MS CDB G Grant Administrators Admi nistra tors or City Clerks Clerk s may now sign the Section Secti on 106 Compliance Forms including Com plian ce Form s inclu ding the Exempt Exem pt from Review Project Determination Revie w Proje ct Deter minat ion Form and the Request Requ est 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 publicand have it witnessed. 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 Appendix FIowa Site Inventory Form State Inventory Number: New Supplemental State Historic Preservation Office 9-Digit SHPO Review & Compliance (R&C) Number: (January 2016) Non-extant Year: Read the Iowa Site Inventory Form Instructions carefully, to ensure accuracy and completeness before completing this form. The instructions are available on our website. • Property Name

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 Appendix E 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 Appendix FF REQUEST FOR COMMENT ON A HUD PROJECT* □ This is a new submittal □ This is more information relating to a previous submittal Cover Letter: Please include a cover letter with a comprehensive description of the Area of Potential Effect (APE) and project activities. The APE should include the project area, all easements, borrow areas, equipment and material storage, and staging areas. If applicable, describe excavation and other earthmoving activities including 3-dimensional parameters (length, width, and depth).