Agenda - 11-05-2015 - 5-a - North Carolina Community Transportation Program Administrative and Capital Grant Applications FY 2017

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6 ATTACHMENT 2 FTA FISCAL YEAR 2015 CERTIFICATIONS AND ASSURANCES FEDERAL FISCAL YEAR 2015 FTA CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE (Required of all Applicants for FTA funding and all FTA Grantees with an active Capital or Formula Project) AFFIRMATION OF APPLICANT Name of the Applicant: Name and Relationship of the Authorized Representative: BY SIGNING BELOW,on behalf of the Applicant,I declare that it has duly authorized me to make these Certifications and Assurances and bind its compliance.Thus,it agrees to comply with all Federal statutes and regulations,and follow applicable Federal guidance,and comply with the Certifications and Assurances as indicated on the foregoing page applicable to each application its Authorized Representative makes to the Federal Transit Administration(FTA)in Federal Fiscal Year 2015,irrespective of whether the individual that acted on his or her Applicant's behalf continues to represent it. FTA intends that the Certifications and Assurances the Applicant selects on the other side of this document should apply to each Project for which it seeks now,or may later seek FTA funding during Federal Fiscal Year 2015. 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 FTA,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 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 by 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 accurate. Signature Date: Name Authorized Representative of Applicant AFFIRMATION OF APPLICANT'S ATTORNEY For(Name of Applicant): As the undersigned Attorney for the above named Applicant,I hereby affirm to the Applicant that it has authority under State,local,or tribal government law,as applicable,to make and comply with the Certifications and Assurances as indicated on the foregoing pages.I further affirm that,in my opinion,the Certifications and Assurances have been legally made and constitute legal and binding obligations on it. I further affirm that,to the best of my knowledge,there is no legislation or litigation pending or imminent that might adversely affect the validity of these Certifications and Assurances,or of the performance of its FTA Project or Projects. Signature Date: Name Attorney for Applicant e Each Applicant for FTA funding and each FTA Grantee with an active Capital or Formula Project must provide an Affirmation of Applicant's Attorney pertaining to the Applicant's legal capacity.The Applicant may enter its signature in lien of the Attorney's signature,provided the Applicant has on file this Affirmation,signed by the attorney and dated this Federal fiscal year.