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CRANE ORANGE COUNTY GOVERNMENT <br /> TRANSPORTATION SERVICES DEPARTMENT <br /> COUNTY OrangeCounty <br /> >Q K I ti C.AROLINA PUBLICTRANS11* <br /> Section I — DCHC MPO 5310 FY24 Application <br /> Date: 7/30/2024 <br /> Project Title: OCTS 3 ADA Passenger Vans for Seniors and Disabled <br /> Section l: Applicant Information <br /> Applicant Legal Name Orange County Transportation Services <br /> Contact Person/Title: Nishith Trivedi,Transportation Director <br /> Address: 606 N. NC 86 <br /> City Hillsborough <br /> State NC <br /> Zip Code 27278 <br /> Telephone#919-245-2007 <br /> DUNS#091575191 <br /> Request Type (Check all that apply) <br /> ❑X Continuation of an ❑X New Project ❑Operating X❑Capital ❑X Mobility <br /> Existing Project Management* <br /> *Application for mobility management funding is encouraged as this funding can be used to assist in program administration through <br /> funding staff responsible for administering the program and can be the main point of contact for DCHC staff. <br /> Organization Type (Check all that apply) <br /> ❑X Local Government Authority ❑ Private Non-Profit Organization <br /> ❑X Public Operator of Public Transportation ❑ Private Operator of Public Transportation <br /> Systems Systems <br /> Supplemental Information <br /> ❑ Copy of current IRS W-9 Taxpayer Identification Form (new applicants only) <br /> 0 Service Area/Route Map (if applicable) <br /> 0 Current Letters of Support for Project <br /> Certifications—See Appendix A <br /> ❑ Drug and Alcohol Testing Policy or Drug-Free Workplace Policy <br /> 0 Local Share Certification <br /> 0 Title VI Plan Certification <br /> 0 EEO Certification <br /> 0 Lobbying Certification <br /> ❑X Traditional Project Certification Eligibility—Units of Local Government (if applicable) <br /> ❑ Private Non-Profit Organization Certification Eligibility(if applicable) <br />