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25 <br />State Fiscal Year 2013 Public Transportation Programs <br />Federal and State Assistance Certifications and Assurances <br />STATE FISCAL YEAR 2013 <br />FEDERAL (FTA) /STATE (NCDOT) CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE <br />(Required of all Applicants) <br />AFFIItMATION OF APPLICANT <br />Legal Name of Applicant: <br />Orange County <br />Name and Relationship of Authorized Official: <br />Bernadette Pelissier, Chair, Board of County Commissioners <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 FederaUState statutes and regulations, and follow applicable FederaUState directives, and comply with the <br />certifications and assurances as indicated on the foregoing page applicable to each application it makes to North <br />Carolina Department of Transportation (NCDOT) for FTA (Federal Transit Administration) and for State assistance <br />in State Fiscal Year 2013. <br />NCDOT and FTA intend that the certifications and assurances the Applicant selects on the preceding certifications <br />and assurances category selection page, as representative of the certifications and assurances in this document, <br />should apply, as provided, to each project for which the Applicant seeks now, or may later, seek State or (FTA) <br />Federal assistance during State Fiscal Year 2013. <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 NCDOT, and acknowledges that <br />the Program Fraud Civil Remedies Act of 1986, 31 U.S.C. 3801 et seq., and implementing U.S. DOT regulations, <br />"Program Fraud Civil Remedies," 49 CFR part 31 apply to any certification, assurance or submission made to the <br />NCDOT and FTA. The criminal provisions of 18 U.S.C. 1001 apply to any certification, assurance, or submission <br />made in connection with a Federal public transportation program authorized in 49 U.S.C. chapter 53 or any other <br />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 />Signature of Authorized Official <br />Date Signed <br />Bernadette Pelissier, Chair Orange County Commissioners <br />Name/Title of Authorized Official <br />Seal Subscribed and sworn to me (date) <br />Notary Public <br />Printed Name and Address <br />My commission expires (date) <br />Affix Notary Seal Here <br />:...... ................................................................................:.........: <br />22 <br />