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ATTACHMENT 2 <br />M <br />STATE FISCAL YEAR 2014 <br />FEDERAL (FTA) / STATE ( NCDOT) 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 Official: <br />Mr. Barry Jacobs, Chair Orange 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 <br />with all Federal /State statutes and regulations, and follow applicable Federal/State guidance, 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 2014, irrespective of whether the individual that acted on its Applicant's behalf continues to <br />represent the Applicant. <br />NCDOT and FTA intend that the Certifications and Assurances the Applicant selects on the preceding Certifications <br />and Assurances group selection page should apply, as provided, to each Project for which the Applicant seeks now, <br />or may later seek State or (FTA) Federal assistance during State Fiscal Year 2014. <br />The Applicant affirms the truthfulness and accuracy of the Certifications and Assurances it has selected in the <br />statements submitted with this document and any other submission made to NCDOT, and acknowledges that the <br />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 />Mr. Barry Jacobs, 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 />41 <br />Date Signed <br />