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Street Address <br /> City , State, Zip <br /> Date <br /> Attachment F <br /> Statement of Assurances <br /> The Recipient hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines <br /> and requirements, including OMB Circulars No . A-21 , A- 110, A422, A- 128 , A- 87 ; E. O . 12372 and Uniform <br /> Administrative Requirements for Grants and Cooperative Agreements 28 CFR, Part 66, Common rule, that <br /> govern the application, acceptance and use of Federal funds for this federally-assisted project. Also the Applicant <br /> assures and certifies that: <br /> 1 . It will comply with requirements of the provisions of the Uniform Relocation Assistance and Real Property <br /> Acquisitions Act of 1970 (P . L . 91 -646) which provides for fair and equitable treatment of persons displaced as a <br /> result of Federal and federally-assisted programs. <br /> 2 . It will comply with provisions of Federal law which limit certain political activities of employees of a State or <br /> local unit of government whose principal employment is in connection with an activity financed in whole or in <br /> part by Federal grants . ( 5 USC 1501 , et seq.) <br /> 3 . It will comply with the minimum wage and maximum hour' s provisions of the Federal Fair Labor Standards <br /> Act. <br /> 4 . It will establish safeguards to prohibit employees from using their positions for a purpose that is or gives the <br /> appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom <br /> they have family, business, or other ties . <br /> 5 . It will give the sponsoring agency or the Comptroller General, through any authorized representative, access to <br /> and the right to examine all records, books, papers, or documents related to the grant. <br /> 6 . It will comply with all requirements imposed by the Federal sponsoring agency concerning special <br /> requirements of law, program requirements, and other administrative requirements . <br /> 7 . It will insure that the facilities under its ownership, lease or supervision which shall be utilized in the <br /> accomplishment of the project are not listed on the Environmental Protection Agency's (EPA) list of Violating <br /> Facilities and that it will notify the Federal grantor agency of the receipt of any communication from the Director <br /> 52 <br /> f - <br />