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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />PARENT COMPANY DUNS# (if applicable): <br />CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA#): <br />DESCRIPTION OF PROJECT (Up to 4000 Characters) <br />Complete eligible Projects for repair or replacement of Disaster damaged facilities. <br />PRINCIPAL PLACE OF PROJECT PERFORMANCE (IF DIFFERENT THAN PRINCIPAL PLACE OF <br />BUSINESS): <br />ADDRESS LINE 1: <br />ADDRESS LINE 2: <br />ADDRESS LINE 3: <br />CITY <br />STATE ZIP CODE+4" <br />CONGRESSIONAL DISTRICT FOR PRINCIPAL PLACE OF PROJECT PERFORMANCE: <br />'Providing the Zip+4 ensures that the correct Congressional District is reported. <br />EXECUTIVE COMPENSATION INFORMATION: <br />1. 1. In your business or organization's previous fiscal year, did your business or organization (including <br />parent organization, all branches, and all affiliates worldwide) receive (a) 80 percent or more of your <br />annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial <br />assistance (e.g. loans, grants, subgrants, and/or cooperative agreements, etc.) subject to the <br />Transparency Act, as defined at 2 CFR 170.320; AND, (b) $25,000,000 or more in annual gross <br />revenues from U.S. Federal procurement contracts (and subcontracts) and Federal financial <br />assistance (e.g. loans, grants, subgrants, and/or cooperative agreements, etc.) subject to the <br />Transparency Act? <br />Yes ❑ No <br />If the answer to Question 1 is "Yes," continue to Question 2. If the answer to Question 1 is "No", <br />move to the signature block below to complete the certification and submittal process. <br />2. Does the public have access to information about the compensation of the executives in your <br />business or organization (including parent organization, all branches, and all affiliates worldwide) <br />through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 <br />(15 U.S.C. 78m(a), 78o(d)) Section 6104 of the Internal Revenue Code of 1986? <br />Yes ❑ No ❑ <br />If the answer to Question 2 is "Yes," move to the signature block below to complete the certification <br />and submittal process. [Note: Securities Exchange Commission information should be accessible <br />at http//www.sec.gov/answers/execomp.htm. Requests for Internal Revenue Service (IRS) <br />information should be directed to the local IRS for further assistance.] <br />If the answer to Question 2 is "No" FFATA reporting is required. Provide the information required <br />in the "TOTAL COMPENSATION CHART FOR MOST RECENTLY COMPLETED FISCAL YEAR" <br />appearing below to report the "Total Compensation" for the five (5) most highly compensated <br />"Executives", in rank order, in your organization. For purposes of this request, the following terms <br />apply as defined in 2 CFR Ch. 1 Part 170 Appendix A: <br />"Executive" is defined as "officers, managing partners, or other employees in management positions". <br />"Total Compensation" is defined as the cash and noncash dollar value earned by the executive during the <br />most recently completed fiscal year and includes the following: <br />57 <br />