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17. ASSURANCES AND APPLICATION SIGNATURE (Applications without an appropriate signature for this item will not be considered for funding): Certification of Standards Statement I, the undersigned, certify that if granted funds under Chapter 401, Part II, F.S.; as amended, all applicable regulations and standards will be adhered to including: Chapter 401, F.S.; Chapter 10D-66, F.A.C.; Minimum Wage Act; Title VI of the Civil Rights Act of 1964.(42 ISC 2000D et. seg.); DHEW Regulation (45 CFR Part 80); Rehabilitation Act (Sec 504); Developmentally Disabled Assistance and Bill of Rights of 1975 (P.L. 95-602) u amended by Title V of the Comprehensive Rehabilitative Services Amendments of 1978: Confidentiality; Human Rights; Habilitation Plana; Employment of the Handicapped; Services for Persons Unable to Pay. Statement of Cash & In-jCind Commitment I, the undersigned, certify that cash and in-kind match will be available during the grant period and used in direct support of this grant project. State and federal funds will not be used for matching requirements, unless specified by law. No costs or third -party in-kind contributions count towards satisfying a matching requirement of a department grant if they are used to satisfy a matching requirement of another state or federal grant. Cash, salaries, fringe benefits, expenses, equipment, and other expenses u listed on this application shall be committed and used for the department's final approved project during the grant period. Acceptance of Terms and Conditions Acceptance of the grant terms and conditions in Appendix C of the booklet, 'Florida Emergency Medial Services Matching Grant Program 1992-93', by the Department of Health and Rehabilitative Services is acknowledged by the grantee when funds are drawn or otherwise obtained from the grant payment system. .11 I, the underigaed, hereby certify that the facts and information contained in this application and any follow-up documents are true and correct to the best of my knowledge, information, and belief. I further understand that if it is subsequently determined that this is not correct, the grant funded under Chapter 401, Part II, F.S.; Chapter 10D-66, F.A.C.; as amended by Chapter 85-167, Laws of Florida, may be revoked, and any monies erroneously paid and interest earned will be refunded to the department with any penalties which may be imposed by law or applicable regulations. Notification of Awardj I understand the availability of the notice of award will be advertised in the Florida Administrative Weekly, and that 30 calendar days after this Florida Administrative Weekly advertisement I waive any right to challenge or protest in anyway the decisions to aw grants. Signature of Authorized Grant Signer (Individual Identified in Item 1) / /- i 9- 9/ Date NOTE: Please check to insure that all required signatures have been made for Items 15, 16, and 17. • 39