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14 <br />Assurance of Participation Form <br />This form provides written assurance that all First Responder disciplines within the county and <br />within all municipalities in the county were provided an opportunity to participate in this grant <br />program. <br />County Manager (or Principal Chief for the Eastern Band of the Cherokee Indians) (signing on behalf of <br />county first responder agencies within the county and largest municipality within the county which provides first <br />responder agencies in that municipality and any additional municipality with a population of 25,000 people or <br />greater)) <br />I certify that all eligible county agencies and first responder agencies in the other municipalities were provided an <br />opportunity to participate in this grant program. <br />County Manager Signature <br />Orange County <br />Jurisdiction Date <br />City Manager (of the largest incorporated municipality within the county who provides first responder services) <br />I certify that my first responder agencies were provided an opportunity to participate in this grant program <br />City Manager Signature <br />Town of Chapel Hill <br />Jurisdiction Date <br />City Manager (if applicable, of any additional incorporated municipality with a population of 25,000 people or <br />greater that provides first responder services) <br />I certify that my first responder agencies were provided an opportunity to participate in this grant program <br />Town of Carrboro <br />City Manager Signature Jurisdiction Date <br />Town of Hillsborough <br />City Manager Signature Jurisdiction Date <br />DHS FY2003 SHSGP Part II Annex B: Subgrant Forms 5 of 7 <br />