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FOR CA FOR (Name of SWRI <br />2001_ _ ._ _- _North Carolina-,-- <br />'j his atmmary shit includes ASSmlrances and Cernficadons that must be read, signed, and submitted as a part of the Application <br />for Federal Assistance. <br />An applicant must check each it:m that they se mrrifying to: <br />Part I ❑ FsMA Form 20-16A Assurances Nonconstruction Programs <br />Part IF F MA Form 20 -16B Assurances-Construction Programs <br />Part III ❑ Fx2AA Form 20-16C Certification Regarding Lobbying; <br />D:barment, Suspension, and Other Responsibility <br />Ma=rs; and Drug =Tree Worlmlace Requirements <br />P=T rV ❑ SF IS L Disclosure of Lobbying Activities (If applicable) <br />As the duly authorized representative of the applicant, <br />assuauccs and certifications. <br />Nick Waters <br />Typed Nan= of uthOezed R-presemative <br />Sigaszus of Autborasd Rep• -- -...•Live <br />I hereby certify that .the applicant will comply with the identified attached <br />Emergency Program Manager- EM Director <br />Tide . <br />February 22, 2001 <br />Dam seed <br />NOTE• By signing th! certification regarding debarment, suspension, and other responsibility spatters for p:iwary covered <br />LMI- Saction, the applicant aU---s that, should the proposed covered transaction be entered into, it shall not imossingly cater into any <br />io�.r tier cov:r.d t-^ ctior_ nth a perscn who ;s dt barred, suspended, d_ -hacd ineiizible, or volunarily cxclud: d `-o*n <br />paricipadon in tE:iS cov.._d =Tlsaz:�on, tel: ss avr:'or'i ^d by Fr""MA ent:.rrg :nzo this transaction. <br />Tn: applicant further agre:._ by submitting this application that it will include the clause titled 'Certification <br />Re_arding D:barm:nt, SuTcrsion, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction,' provided by the <br />T MA Regional 05c: cn:zring into this covered transaction, without modification, in all lower tier covered r-AnG^tions and in all <br />soiicimtions for loarr ti:r covered transactions. (Refer to 4: Cr Part I7.) <br />Paperwork Burden Disclosure Notice <br />'Public repo-:ing burden for this form is estimated to average 1.7 hours per response. The burden estimate includes <br />1 the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and <br />completing, reviewing, and maintaining the data needed, and completing and submitting the form. Send comments <br />1. retarding the accwacy of the burden estimate and any suggestions for reducing the burden to: Information <br />`Collections Management, f=ederal Emergency Management Agency, 500 C Stress, SW, Washington DC 20472.' <br />i <br />BMA Form 20.16. JUL 95 <br />15 <br />