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Southeast Florida <br />A <br />IIHAVIONAI MTH HET.!! <br />B. This certification is a material representation of fact upon which reliance was placed <br />when this transaction was made or entered into. Submission of this certification is a <br />prerequisite for making or entering into this transaction imposed by section 1352, Title <br />31, U.S. Code. Any person who fails to file the required certification shall be subject <br />to a civil penalty of not less than $10,000 and not more than $100,000 for each such <br />failure. <br />Signature <br />Name of Authorized Individual <br />Indian River County Board of County <br />Commissioners <br />Name of Organization <br />Address of Organ! <br />Date <br />AGR75 <br />Application or Contract <br />Number <br />Certification Packet <br />5 Agreement No.: AGR75 <br />Indian River County Board of <br />County Commissioners <br />146 <br />