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AMEMMIIMII <br /> Form GHSP-D-03 <br /> PART V(B) <br /> ACCEPTANCE OF CONDITIONS <br /> This application is approved for fiscal year <br /> highway safety project is granted subject to the State and Federal Ws and regulations to proceed with this <br /> the North Carolina Governor's Highway Safety Program and the conditions tated ono wpplicable to <br /> 1. Unless otherwise directed, applicants must submit below. <br /> which reflect the status of project implementation and attainment f stated goals.Each <br /> • report shall describe the project status quarterly and shall be Quarterly �� Reports to the GHSP <br /> fifteen(15)days subsequent to the termination of each quarter.A Final Accomplishment progress <br /> e submitted to GHSP no later than <br /> (Form GHSP-D-10)must be submitted to the GHSP within thirty letion of he <br /> project unless otherwise directed. Appropriate forms will be mailed to Prof ct Diireectoralo g <br /> with a reminder notice advising date that each is due. <br /> along <br /> 2. Applicants making purchases or entering <br /> as provided for by this project must <br /> adhere to the policies and procedures of Attachment 0 of OMB Circular A-1 <br /> whichever is applicable. A-102 or A-110, <br /> 3. All Out-of-State travel must have prior approval of the Governor's Highway Safety P <br /> Requests for approval (Form GHSP-A-17) should be submitted to GHSP at least two 2 <br /> before the intended date of travel. y rogram. <br /> _ ( ) weeks <br /> 4. Applicants must submit any proposed agreements for contractual services to the Gove rnor's <br /> Highway Safety Program for final approval prior to acceptance. <br /> 5. Applicants shall account for program income related to projects financed in whole or i n part <br /> with federal funds in accordance with Attachment E of OMB Circular A-102 or Attachment D o <br /> OMB Circular A-110, whichever is applicable. Program income earned during the c <br /> period shall be retained by the applicant and added to the,funds committed to the project of <br /> GHSP and be used to further eligible program objectives. p sect by the <br /> contract <br /> 6. Local government applicants must complete Attachment 1 entitled "Local <br /> Resolution". Governmental <br /> 7. Any continuation of this project with funds from the State of North Carolina is contingent upon <br /> State funds being appropriated by the General Assembly specifically for that purpose. <br /> r <br /> PROJECT DIRECTOR Read the above"Conditions"before st.nin• <br /> NAME__ <br /> TITLE <br /> Mary Bobbi tt-Cooke ADDRESS <br /> Health PrgFnotion Coordin_tor P.O.Box 81$1,Fiillsborou2h <br /> SIGNATURE - 2 7 2 7$C <br /> ��=1.. TELEPHONE NUMBER 1V <br /> AUTHOR! ING OFFICIAL OF GOVERNMENTAL UNIT Read the above"Conditions"before si••nin 181 1~xt'305 <br /> NAME <br /> TITLE <br /> Daniel $. Reimer Di ADDRESS <br /> rector, Health Dept. P.0.Box 8181, Hillsborough, NC 27278 <br /> SIGNATURE alr Q <br /> lir <br /> !� TELEPHONE NUMBER <br /> 7 <br /> OFFICIA OF GOVERN,ENTA NIT AUTHORIZED TO RECEIVE FUNDS UNDER THIS PROJECT Ext 305 <br /> Pr <br /> Iiiirlitt/ ■ t/ , , TITLE <br /> ADDRESS / <br /> Chairman <br /> P.O. Box 8181 ; Hillsborough, NC 27278 ORGANIZATION <br /> APPROVAL INFORMATION FOR GHSP USE ONLY Orange Co. Board of Commissioners <br /> APPROVAL DATE <br /> IMIIIIIIIIIIITIIMIIIIIIIIII <br />