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Local Share Certification for Funding <br /> (This form is required for EACH separate funding request) <br /> Orange County <br /> (Legal Name of Applicant) <br /> Local matching funds will be required for all application submittals. For projects requiring capital funds,the <br /> required local match is 10 percent of the net cost of the project,subject to the availability of state funds. Applicants <br /> should be prepared to incur a 20 percent local match in case state funds are not available. <br /> The local match must be provided from sources other than federal Department of Transportation funds. Guidance <br /> is provided FTA's website about eligible sources of matching funds. Applicants are responsible for verifying the <br /> eligibility of non-USDOT federal funds the applicant proposes to use as their local match. <br /> Requested Funding Amounts <br /> Net Local Share Local Source(s) <br /> Proj ect <br /> Cost <br /> Capital $212,902 $21,290 (10%) 1.Local General Operating <br /> Fund <br /> (Vehicles&Other) <br /> 2. <br /> 3. <br /> TOTAL $212,902 $21,290 <br /> I, the undersigned representing(Legal Name of Applicant)Orange County do hereby certify to the North Carolina <br /> Department of Transportation,that the required local funds will be available as of July 1,2017. <br /> (E� fill 1u- - <br /> Signature of Authorized Official <br /> Farl McKee Chair of the Board of County Commissioners <br /> Type Name and Title of Authorized Official <br /> 5-11 <br /> Date <br />