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State Fiscal Year 2010 Community Transportation Program <br /> 5 Federal Assistance 5311 Certifications and Assurance <br /> FEDERAL/STATE CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE <br /> (Required of all Applicants) <br /> AFFIRMATION OF APPLICANT <br /> Legal Name of Applicant: <br /> Orange County <br /> Name and Relationship of Authorized Representative: <br /> BY SIGNING BELOW,on behalf of the Applicant,I declare that the Applicant has duly authorized me to make <br /> these certifications and assurances and bind the Applicant's compliance. Thus,the Applicant agrees to comply with <br /> all Federal statutes,regulations,executive orders,and directives applicable to each application it makes to the <br /> Federal Transit Administration(FTA)and for State assistance in State Fiscal Year 2010. <br /> The State of North Carolina and FTA intend that the certifications and assurances the Applicant selects on the other <br /> side of this document,as representative of the certifications and assurances in this document,should apply,as <br /> provided,to each project for which the Applicant seeks now,or may later,seek State or FTA assistance during State <br /> Fiscal Year 2010. <br /> The Applicant affirms the truthfulness and accuracy of the certifications and assurances it has made in the <br /> statements submitted herein with this document and any other submission made to the State and FTA,and <br /> acknowledges that the Program Fraud Civil Remedies Act of 1986,31 U.S.C.3801 et seq.,and implementing <br /> U.S.DOT regulations, "Program Fraud Civil Remedies,"49 CFR part 31 apply to any certification,assurance or <br /> submission made to the State and FTA. The criminal fraud provisions of 18 U.S.C. 1001 apply to any certification, <br /> assurance,or submission made in connection with a Federal public transportation program authorized in 49 U.S.C. <br /> chapter 53 or any other statute. <br /> In signing this document,I declare under penalties of perjury that the foregoing certifications and assurances,and <br /> any other statements made by me on behalf of the Applicant are true and correct. <br /> Name/Title of Authorized Official <br /> Signature of Authorized Official <br /> Date Signed <br /> 17 <br />