Orange Co signed Certs Assurances

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STATE FISCAL YEAR 2014 FEDERAL FTA / STATE NCDOT CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE (Required of all Applicants) AFFIRMATION OF APPLICANT Legal Name of Applicant: Orange County,North Carolina Name and Relationship of Authorized Official: Barry Jacobs,Chair,Orange County Board of Commissioners BY SIGNING BELOW,on behalf of the Applicant,I declare that the Applicant has duly authorized me to make these Certifications and Assurances and bind the Applicant's compliance. Thus,the Applicant agrees to comply with all Federal/State statutes and regulations,and follow applicable Federal/State guidance,and comply with the Certifications and Assurances as indicated on the foregoing page applicable to each application it makes to North Carolina Department of Transportation(NCDOT)for FTA(Federal Transit Administration)and for State assistance in State Fiscal Year 2014, irrespective of whether the individual that acted on its Applicant's behalf continues to represent the Applicant. NCDOT and FTA intend that the Certifications and Assurances the Applicant selects on the preceding Certifications and Assurances group selection page should apply,as provided,to each Project for which the Applicant seeks now, or may later seek State or(FTA)Federal assistance during State Fiscal Year 2014. The Applicant affirms the truthfulness and accuracy of the Certifications and Assurances it has selected in the statements submitted with this document and any other submission made to NCDOT,and acknowledges that the Program Fraud Civil Remedies Act of 1986, 31 U.S.C. 3801 et seq.,and implementing U.S.DOT regulations, "Program Fraud Civil Remedies,"49 CFR part 31 apply to any certification, assurance or submission made to the NCDOT and FTA. The criminal provisions of 18 U.S.C. 1001 apply to any certification,assurance,or submission made in connection with a Federal public transportation program authorized in 49 U.S.C. chapter 53 or any other statute. In signing this document,I declare under penalties of perjury that the foregoing Certifications and Assurances,and any other statements made by me on behalf of the Applicant are true and correct. February 26,2013 Signature of Autho F—d ' cial Date Signed Barry Jacobs,Chair Orange County Board of Commissioners Name/Title of Authorized Official .................................................................................... Affix Not Seal Here Seal Subscribed and sworn to me ( to V) 4—?�\ul _ 1`� �tii r i P lil, U is N= NOTARY PUBLIC G O,p Printed Name dddAcldress � My commission expires (date) 41