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Federal Register / Vol. 74 , No . 200 / Monday , October 19 , 2009 / Notices 53577 APPENDIX A FEDERAL FISCAL YEAR 2010 FTA CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE f Required of all Applicants for FTA assistance and all FTA Grantees with an active capital or formula project) AFFIRMATION OF APPLICANT Name of Applicant: �f1 i `` K �� '�► Name and Relationship of Authorized Representative: BY SIGNING BELOW, on behalf of the Applicant, I declare that the Applicant has duly authorized me to make these certifications and assurances and bind the Applicant' s compliance. Thus, the Applicant agrees to comply with all Federal statutes and regulations, and follow applicable Federal directives, and comply with the certifications and assurances as indicated on the foregoing page applicable to each application it makes to the Federal Transit Administration (FTA) in Federal Fiscal Year 2010. FTA intends that the certifications and assurances the Applicant selects on the other side of this document, as representative of the certifications and assurances in this document, should apply, as provided, to each project for which the Applicant seeks now, or may later, seek FTA assistance during Federal Fiscal Year 2010. The Applicant affirms the truthfulness and accuracy of the certifications and assurances it has made in the statements submitted herein with this document and any other submission made to FTA, and acknowledges that the Program Fraud Civil Remedies Act of 1986, 31 U.S .C. 3801 et seq . , and implementing U .S . DOT regulations, "Program Fraud Civil Remedies," 49 CFR part 31 apply to any certification, assurance or submission made to FTA. The criminal provisions of 18 U.S .C. 1001 apply to any certification, assurance, or submission made in connection with a Federal public transportation program authorized in 49 U.S .C. chapter 53 or any other statute In signing this document, I declare under penalties of perjury that the foregoing certifications and assurances , and any other statements made by me on behalf of the Applicant are true and correct Signaturej �( Date: (� Name l — k I r " ! G. ' S O 'e1 Authorized Representative of Applicant AFFIRMATION OF APPLICANT' S ATTORNEY For (Name of Applicant) : �h ' " t" ( • Veep As the undersigned Attorney for the above named Applicant, I hereby affirm to the Applicant that it has authority under State, local, or tribal government law, as applicable, to make and comply with the certifications and assurances as indicated on the foregoing pages. I further affirm that, in my opinion, the certifications and assurances have been legally made and constitute legal and binding obligations on the Applicant. I further affirm to the Applicant that, to the best of my knowledge, there is no legislation or litigation pending or imminent that might adversely affect the validity of se certifications and assurances , or of the performance of the project. Date: i Signature Name �✓' �`` � I t � 1 � G Attorney for ApplicAt Each Applicant for FTA financial assistance and each FTA Grantee with an active capital or formula project must provide an Affirmation of Applicant' s Attorney pertaining to the Applicant's legal capacity. The Applicant may enter its signature in lieu of the Attorney' s signature, provided the Applicant has on file this Affirmation, signed by the attorney and dated this Federal fiscal year. Attachment 3