HomeMy WebLinkAboutAgenda - 12-03-2001-8lORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 3, 2001
Action Ag ~ 1
Item NO. x_(
SUB.IECT: ResoWtion b Apply end Enter into Agreement with the North Camlina
Department of Transportation for Communtty Transportation Progrm (GTP)
DEPARTMENT: Aging/OPT PUBLIC NEARING: (V/N) No
ATTACHMENT(S): INFORMATION CONTACT:
Jerry Passmore, ex12009
Public Hearing Notice Mike Eyster, Chair
CTP Application
Annual Resolution Statement TELEPHONE NUMBERS:
Section 5333 (b)FTA WenantY NIIlsborou9h 732.8181
Chapel HIII 968A501
Durham 888.7337
Mebane 336-827-2031
PURPOSE: To au[hotlze an Annual Resolution Statement for Community Transportation
Pmgmm antl approve an agreement with the NoM Camlina Department of Trensportaton
(NCDOT) for Fy 2002-2003 for submission to the State.
BACKGROUND: On December 19, 1995, the Orenge County Board of Commissioners
approved [he Count's current Transportation Development Plan (TOP). The Plan makes
Orange County eligible far fetleral and state grants to offset County costs assocetetl wRh
operating the Orange Public Transportation (OPT)prtgrem. These Brent funds covers portion
of the County's costs of vehidea, equipment antl adminiafmgve overheatl. Staff anticipates.
uptlating the currant Plan and submMing it to the Commissioners in spring 2002.
The attached agreement is effective with Me upcoming 2002-2003 fecal year. According b the
application, the County can anticipate Communhy Trenspoda8on Program Brent funds to offset
generel adminisbative overhead in [he amount of $140,263. One of the requirements of the
gran[ is that the Coumy must provitle a local match of $29,752 in the budget for the upcoming
2002-03 fiscal year. The grant funds would support OPT system managemen[and continue to
promote general public rider ship. This atlministmtive support retluces the cost of each trip by
approximately 20 percent, and results in an increase of 20,000 [dps per year, or an average of
450 idps per day.
As required by the gent agreement, Ne Orange County Human Services Transportaton Uoek
contluc[a0 a public hearing at its November 27, 2001 meeting. Following the public hearing, the
Tronspodation Boats revlewetl and approvetl the grant applicatlon. Staff will forwartl written
and oral commeMS[o the NCDOT along with the grant application. The application ie duob
[he State no later than December 14, 2001.
FINANCIAL IMPACT: Revenue aswcialetl wRh this agreement will be inmmorated In the OPT
budget requaet tar the upcoming 2002-03 fswl year.
RECOMMENDATION (S): The Meneger remmmentls that the Board of County Commissioners
approve the submission of the FY 2002-2003 eppliwtion for NCDOT Community Trenspodation
Pmgmmiuhds antl authorize the Chair to sign Me Annual Resolution statement antl Special
Section 5333 (b) WarrarM1y.
NORTFI CAROLINA
ORANGE COUNTY
AFFIDAVIT OF PUBLICATION
Befose Ne maemigned; a Notup Public of said County and
Sta[q dWy wnwiaaioned, gvalifieq mtl aumvrisaa by law to
adrvivisteacaths,personapyeppeared
o E ~ who being use duly
m, aepvsesenasays: Natye (ahe)ismauNmizedemployeeof
Tye Nears of Oasvge Cvuvry, engaged w Ne publication of a
newspaper kvow¢ as The News of Oaavge Comty published,
ssuea, ane emend as se rood Gaaa mail iv Ne Ciry o1'Ni-sborough,
in said County and Stam; then he (she) is euthot¢ed to make Nis
affidavit and swum smtemevq Nm Ne votlce os oNerlegW adver-
nsemmt, atrue ropy of which is attachedyercto, weapvbhaMd in
The News of Orange Cou¢ry ¢v Ne fvllowivg darca:
Navembe[ 19, 2001
and Net Nesaia¢<wspape.i¢whichsu hvonce,papeq documegq
or tegy advenixmem was pvblisyed was, at the time of each and
zveey such pvbticado4 a vewspapez meeting all of Na aequia -
ems and qualifiesdovs of Secrte¢ 1-591 of the Genewl Smwtes
o`. North Carolina and was a qualSied vewapaper wiNw Ne mea¢-
ivg of 9ec[ion 1-591 of Na Omenl Smmme of NmN CaroWa.
This 1919=_h day ofovember ,2001
(Sig tore of pamovm ing affldavtt)
Swamm and subsrnbea before me, Nis itfTR
day of Y7 ,,.„p, ztrol
~~,.,~~ oP, ~e
~Nara<y rabuo) ~ Q.,
My COmmiesivn [xpires /(7s~ ~vn a.~aOOc2
CLIPPING OF lFpgL
ACVERTSEMENT
g1T4CXEp f1EHE
¢FY 20p3 CO~,nlyTrevepmnem Pmgam
Fetlenl $vcti0a 5311 LVdfi~me gpdpyueepcel
Page 1 e(IB
CERTIFICATIONS AND ASSURANCES FOR FTA ASSISTANCE PROGRAMS
S¢aipn 5311
L CERTIFICAT NS AN ASSURANCES REQUIRED OF (`N APPLIC NT
EecM1 aubr¢ciplenl of FTA Federal assisbnce awartletl b NCDOT coos! make all
cerNFlCaglpns and eeaurances in Nis Dategary I. Aecertlingly, NCDOT may not
award any Fetleml aseiefanca unDl the Appliont prpvitles assurance PI
wmpllanw by seleRing Category L
A AuthpdN Of Appll(2n[and lfe Representative
The auMprized representatNe pf the Applignt and legal counsel who sign IM1eae
cetlMCadons, assurances, and agreeman6 etleet Nat boN Ne Appllcant antl its
aud~or'va0 representative have adequate auihpdty under state antl IPral law and
the by-loos pr InRmal rulec of Ne Appliont pryeniretipn tp:
(p Exewte antl gle tlia appllcetlw loi Fetlerel assurance on behalf of th¢
APPlirent,
(2) Exewte antl fle Ne requlretl certl0wtbns, essurences, antl agreements on
behalf pf the Applicant b'vding Ida Applion6 end
(3) Execute grant antl wpperetive agreements with NLpOT for FTA assistance
on behalf of Ne Appllcant.
B. Sandartl Aeeurenwc
The Applicenl a9¢Ne6 that It will comply wIN ell apprieable Fetlerel steWteS,
regulafons, exawdve ortlers, FTA cirwlars, antl other Fetlerel atlminislredve
requiremanls in cerrying out erry gaol or ceoperetNe agreement awsaetl by
FTA. The Applicenl ackngwkdgas fiat a is untler a confinuing obligadop b
comply wiN the terms antl wndiCwna of the Brent or cooparetNa agraemenl
Issued for Ib approved prolaf vAth NCDOT for FTA. The Appllcant understands
that Fetlerel laws, regulations, pplicles antl admlrtlsYretNe practlces might ba
modifetl imm time to Lima and affect the implementation of the pmjec[, The
Applicant agrees Nei Nempet recent Federel requirements will apply to Me
protect, unless FTA issues a written detennlnatlon oNerwise.
C. p b tlON R M
AB required by USOOT regulatiena on Govemmentwide Dabazman[ and
Suspension (NOnprewremenv) at 4B CFR 28.S1D:
(1) The Appliont rortDea bfiebest of its knowledge and belie[NeiRentl iu
pdndpals~,
(s) Are not presently debarred, suspentleq proposed far deba~tneng deGaretl
Ineligible, or voluntedly exdutletl from wvere0 tmnsaptlQ'p by any Federal
depadmeM or aganry;
SPV p003C®vaeiry irevspoesma Program
Paga2of 18 FetlmlSatlao UllCw5ya~aed ASyy¢nm
bean wnvidatl
Ol local)
statutes; or mmmisaion of embezzlr
tlesfrvction of recema, making tales
state or
- ~ - w Pcima precemn9 mis mrNicabon had one or
more public trenaactlons (Fetleral, elate Or long t¢nninafetl for reuse or default.
(2) The Applicant dla0 mtliges char i( later, a becomes aware pf any irrformaam
mntradicdng Ne siafemans of pamgrapha (e) through (tl) shove, II will promptly
prpvitle that infolmetlen ro FTA
(9) It the Applicant is unable VO cedifymthe statements wlMln paragraphs (1)antl
(2) above, II shall intlicate so on its SignaWre Page antl prwitle a wmten
explanation to FTA
D. Dmp-Fr W
Ae requlretl by U.S. DGT regulations on Drvg-Fr¢e Workplace Requinm¢nta
(Greats) e[ 48 CFR 29, Subped F, e9 motllfietl by 41 U.S.G. ]112, Me Applicant
cerages that it w111 provide a tlrvB-tree wprkplam by:
(1) Publlahing asa:ement nolifying employees that Ne unlawful manufacture.
distdbudpn, tllspensing, passeeaioq or use of a mnVOlletl substance is
prohlDltetl in the Applicants workplace antl spaWtying the actions mat will be
taken against employees for violation of such pmMbition,
(2) Establiahing an ongoing drvg-free awareness pragnm ro Inform its
employces about:
(a7 The dangers of dmg abuse in Me weAplaw;
(b) ThaAppgcant's pollcyMmeinlaining atlmg-freO weMDlace;
(c) Any avalleble tlrvg counseling, rehabilitation, and employee essislanra
programs; and
(tl) The penalties that maybe imposetl upon Employees b tlrv9 abuse
Nolagona pmuning In the workplace;
(3) Making it a requirement that each of iK employees to be engagetl in the
pertomanra of fie grant ar cpppareftve agreement ba given a copy of the
statement requiretl by paragraph 11 ):
(4) Notifying each of its employees in the statement requiretl by paragraph (1J
that, Ba a wntlmon IN errployment Mancetl with Fed<ml assistance proNtleO
Dy the gmnl or woperatNe agreement, tM employee wlll:
(a) Abide by Nelerms of the sfatemenl,end
(b) Notify ma employer (apPllcaM) in writing of hie e• her conviction fir
viplemn IN a aminal dmg atawte oaumng in tla workplace rap
later than rive (b) calendar data otter such conviction;
(5) Notifying NCDDT ant FTA In waling, wiNin ten (1p) wkntler days alter
rxaiving notice under pamgrapn (q(b) from an employee cr ptherwiae
SFY PW3G~mi0i Pr'wSaa NO6am
Pege3 of 18 P°~°t sectlou 5311CwfiywusWpuurm;er
receiving actual noti¢INSUCh mnvicoon. EmployersMwnvinea
employees must provitla notice, including position title, W every projen
offwr or gmer. tlesignce on whose project adrdry the convicted employee
was urorking. Nollce shall indutle FM1a identi(cation number(s)vl each
affected gram or pwperetlva agreement
(87 Taking one of Ne follDwin9 actions, w1Nin thirty (30) wlentlar days IN
rereMnq notce under paregreph (47(b), wkh respect to any employee who la
se wm;dad;
ta) Taking appropdam personnel action against cuch an employee, up to
and inducting tenninatioo, consistent ivlN the requirements of the
Rehabilitation An of t9I9, as emendeq or
(b) Requiring such employee to paNdpate sa[iatactcriiy'm atlrug abuse
assistanw Or rehabilitation program approvatl far such pury¢a¢9 by a
Federal, state, or local health, law entorrement, or other epproptlate
agenry;
(]) Making egootl faith effortW wntlnue to malntainatlmg-free workplace
through Implementation M par~Trephs (1 J, (2), (3). (d), (5); antl (3).
The Applicant aBrea ro maintain a Its[ identifying Its headquarters location
and each workpleca A maintains In which proJxt adMtles supportdl by FTA
are wntluctetl and make that list reatlily accessible to NCDOT antl FTA.
Ae required by 4B U.S.C. 5332 (which prohibde tlisaiminapan on the basis of
e, color, creed, national origin, sea or age antl prohibes dlscrlminatlon in
employment or business dppptlUnities) and Title VI m the CMI Rights Act of 1984,
mentletl. 42 U.S.L. 299gtl antl U.3. GGT regulatlona, "NOntllacriminatbn In
Federally-ASSinetl Programs ofine Department of Transpotlation -Effectuation of
TNe VI o! the CNiI Rights An,' et 49 CFR 21 at 21.], the Applicant assures Ihal It
v411 wmply wiM all requirem¢nts pursuant to4B CFR part 21; Ffp Circular 4]02.1
"Title VI Pmgrem Guitlellnee for Fetlerdl Transit Pdminiatrotion Recipients"; antl
other applicable directives, so Mal no person in Na United States. on the basis or
rat, wbr. nafbnal origin, creed, sex, or age will be excluded from pa111dpa0on
in, De tlenibtl the bdnefh M, or omerwlse be subledetl m disdimination in any
progmm or anlvlry (pediwlady in me level and quality of mess transportadan
rdcas andmass transportation-relatetl benethe) for whirlr the Applicant
receivae Fetlerel financ'el assidanw from the U.S. OOT or RA as folloum
(1) The Applicant azzurea mat eaM profeM will be wndUGeQ property
ayuisNgns will ce untledsken, and projeMfaGlitles will be nperatetl In
wmplianc¢ whh all requirements of 49 U.S.C. 5332 end 49 CFR part 21, antl
UndeRtaM6 Vlat thb 8ffiYAnG axl®nds MI I{E @mIR fatality and la faG11125
operakd in wnnenlon wgh Rte DroJecL
(2) The Ppplicantassures that It will take appropriate action Ydensure the[any
Irensferee reviving propertyflnancetl with Fetlerol assistance derived from FTA
will comply wiN the applicable requlramwts of 49 U.S.C. 5332 and 49 CFR patl
2t.
spry zoo] cavmeairy rr.pgpq@eon Pm®am
teasel saMp S?II Cn1i5{aYppr gpdgA,uapcec
PegeJ Of l6
(3) The pppllcant esawBS [hat it will promptly lake the necessary actions b
efteduate this assurenca, indutling notifying the public Ns[ OomplelMS of
tliscdminayon In tlfe providon of iransporladomreleteb swims or bebe9k may
ha tiled wllh U.B. DOT or FTA. Upon request by NCDOT, USOOT or FT0. the
Appllpenl assues that X vnll submit Me required informatlon pertaining to ifs
compliance with tllese requlrcmeMS.
(4) The AppligMassuree Mal it will make any changes in its
49 U.S.C. 5332 end Ti9e V1 implementing pmcetlures as DS. DOT
or FTq may request.
(5J As required by q9 CFR 21.] (a), the Ayplicant will inGUtle tlausas in each
GIiN pehy mntraG or suDagroement b Impose me requlromente N 49. U.3 C.
5332 antl 49 CFR part 21, and indutle appropdate provl3i0ns imposing those
requiremante in tleetls antl InsWmen[3 remrtling the transfer of real property,
stmdures, impmwmenfa.
F. DlsatlvaMacetl Bus'nes Erde Ass
In eccreytlenm wiN 49 CFR 26.13 (a), the Pppllcent assures that It shell nM
tlisaiminate on the basis of 2m. rotor. national Origin, in the awaN and
performance of any thirtl party contract, or subegreement supportetl wM Fetlerel
assistance derived from the U. S. DOT or in the atlMnisiretlon of its OBE program
a lha requirements 0549 CFR part 2B The Appllmnt a3avros fhathahell take all
awry and reasonable s1eDS untler 49 CFR part 26 to ensure
ontlisaiminatlon In the ewartl antl atlminbtraiion of aA IhiM party mnireda end
subegreemenfs approved by U.9. DOT, i3lnmrppreted by reference antl paAd
the grant agre¢manl behveen fhe Applianf and NCDOT. ImplemaMatipn dYhk
OBE Dmgrem is a legal Oblgadoq and failure fo wny Out i6 felms shall be
Yreatetl as a violation of the grant agreement. Upon notifigdon Oy the NGOOT
antl/or FTA M the Applicant of iU failure l0 implement 93 appmwtl DBE program,
Ne NCOOT antl U.B. DOT may Impose eanctbns as prndtle0 far under49 CFR
perry 26 and may, In BPproPde[e cases, refer 0e matter far enformmenl untler 18
V.S.C. 1001,endlor the Program Fraud GiNI Remetlies AG, 31 LL3.C. 3801 et
seq..
G. Asaurenm d N d the Ba ' f 0' bIIIN
As requirotl by U.3. DOT regulations, "NOntllscriminafion On ih0 Baeis Of
HatMiwp in Programs and Acdvltles Receiving or Benefiting from Potlerel
Flnencbl Asaistanm,"49 CFR pert 2T implementlng the Rehabilitation Act of
18]3, es amentleq end the Amedcens wtlF D'ISabilitiee Act M t9BO, az gmende$
Ne Applicant a8saree that as a mntlitign b iha approval Or extensbn of airy
Federal finandal assisdnce from FTA b mnsfmd any fan9ty, obtain any idling
8todt 0! ofhEY egUipnWnt, untlerldke $ipdias, COntlud researdl, arto parttipdt¢ in
or obtain any bane9l frpn any Drogrem atlminuteretl by FT0. no OthenNSe
qualhia] pareon with a disaDlllry Shall be, solBly by rea3an of lhgt diaeDiliry,
asludetl from particlpetlon In, denigtl the Oenefib oC er olherniae supleMetl to
tlisvlmination in any program or activity receMng or benerldng from Fatlerel
9nandal assistance etlminizteretl by the RA or any anfib' witllin U.B. DOT. The
sFVZgm com~;yn®:Pw1,ewP„~.m
Fetlml9eeAw 5311 CMiI'rr4wB Badgmurmcec
Page 5 a(IB
gpplimnt assures the[ prged implement¢lion antl operedons so asalsletl will
comply with all applicable requirements aF USDOT re9ula6ons Implementing the
RdhabAbetion Ad of 1 W2, as amended, antl Gee Amaecans wim Dlsabllleee set M
1990 (antl enysubsegU¢nt amAxttlments Ihere[o) at d9 CFft pans 2], 6], antl 3B,
as well as ell appllcebla regulations end tllmdlves ksuetl by other Federl
depanmanta w agencies.
H. Procurement Cormll
The Appllmnt ceAifes That As precuremenlp and precurement system will mmpy
wiq all applicable requirements impasetl by Federal laws. exemtive orders, or
regulations antl the requlremenp of FTA Cirmlar 422o.i0,'ThiN Perry
ContreNng Gulgelines,• and other ImplemenAnB requirements FTq may issue-
me Applicant cenifies that ttwill intlude in its Mud pant monads financed In
whole or in party wnh FTA assislenceall tleuaea requiretl by Faeerel laws,
executive oNars, or repulaiiona, ene will ensure that each subretlplenf aria
mnoador will also Intlutle In Its subagreemenn antl mnhacte financed In whole
In parry with FTA assisUdde an apPllpble douses requirotl by Fadaral laws,
e%aCUtNe IXdere, or fagul9EOV.
I. CeRfimfion P 'b db th Off d t tla d tlgFJ218 d
SF<2AO)
The Applicant caraflae loaf lb
(t) Hae the legal aumpny tcapply for Fetlelal asslstahm ene meinaftu[loner,
managerial antl financial capability (indutlinp funtle suffident [e pay non-
fetlerel share of0rojed maq mereura proper planning, management antl
completion of tlfe project tlesnibetl in i6 appliradon.
(2) Will grva FTA, tM1e Comptroller General of the United Btaies, antl NCDOT,
fnrough any eu1Mr¢etl repeseMetNe, stress N and me Aghl b examine sll
romrda, books, papers or tlocbments relefetl to the awak; ene will aetabllah
e vrocer accounting system In ampMance with generely acceptetl
accounting sfandaMS ar agency dlrecAVes.
(31 WIII esleblish sefeguams to prohibit employees from using their positions far
s purpose that mnadtutes or presents the appearznw of personal or
organicatbnal conflict of InwreH or personal gain.
(dJ WIII InNdt6 antl complete Aye work within Me applicable pmjedtime DeAOds
following receipt of notlllceAOn by NCDOTyf FTA approval.
(5) WIII mmpywl0 ell daWes relating to nontliscnminatlen indudi~, but no[
limited to:
(aJ TAIa VI of the CINI Wghfs Ad, 42 U.S.D. 2gggtl, wfiich prohibits
tlisoiminaEOn an me basis W lace, color or national origin;
(bj The Ix of the Edumlien Amendments of 19]2, ac amentled 20 U-S.G.
1881, tBB3, and 1665 through 16B], which prohibits tllcerlminafion on the
basis dsex;
SPY}903 Cp~umiy Tremvceudov Pm~am
Page 6x(18 FWmal$ttdpptl311 CeN9atvns evd(ummm
(c) Section 504 of Ne Rehebiliiation Act of 19]3, as amendeq 2B U-SA.
]94, which prohibits tliswiminatlon en the basis of hantlirsps;
(d) The Age DiacdmiW4on AG of 19]5, as amendee, 42 U 5.6101 thmugh
61 W, which prohipps tllsaiminatlon on Ma basis of age;
(e) The ONg Abuse OR¢e antl IIealmeMAC[ a! 19]2, Pub. L. 82-256,
March 21,19]2, antl amentlm~ts IherMO, relatlng to npntliecrimination
on the basis of tlnp abuse;
(f) The Comprehensive AlcUgl Abuse antl Alwholism Prevention AC of
19]0, Pub L B1-0i6, December 31,19]0, and amentlments 1M1ereto,
relaang to noMiscdminaGOn on Me Oasis of alcohol abuse or alcoholism;
(g) The Public Realih Serviw An of 1912, as amentled. 42 V.S C. 29Ddd-3
antl 2BOee-3, reJatetl re cOnFltleMielity of alcohol antl tlmg abuse patient
rewNS;
(h) Title VIII of Me CiNI Rights Ad, 42 LLS.C. 3601 et seq., relating m
nondiacriminatlon in file sale, rental or financing of housing:
(i) Any oNer nondiscrimination proNSbre in the spedDC st8lues antler which
Federal eeaiatance for iha prOjaM may be prOVitled ino'utling, Gut M
liml~sd b SeGlon t tot (b) of Me Trer¢podaiion Equity Act far Me 21"
CenNry, 23 LLS S 101 noie, which prwitlea for Dertltlpatlon of
dleedvaMagetl busineve enbrprises b FTA pmgams; antl
G) The requlremente of any other noMBCrimina6an s[aWe(s)ihat may apply
to this prgeM.
(B) WIII mmply, Or has wmplletl, wiM the requirements Of TMea II antl III of the
Uniorm Relocation Assistan®antl Real Property Acpulsidon Polices Act M
1870, as amended, (Uniform Rebwtlon AM7 62 U.S.C. 4301 e(seq., whits
provide forfeit end equpable treabnent of persons displaced or whose
property is acqulretl as a resua of Fedar4l orfederelly-assisted programs.
These requirements apply to all inlereet6 in real propeM acquired for prged
purposes regeNless cF Federal partiupalicn in purM¢ses. As required by
U.3. DOT requlabona.'Uniform Relou~iw Aesisnn.P a,.a ao~i a,.,..om,
06D1 et s W n~ mn regwremen¢ pr me Vmlo'm Rela~'aapn AC, 42 U.S.C.
eq., antl U.S. 0OT regumtions"Unhofm Relocetlon Aasismnw antl
Real Property Acquisition for Poderzl aM Fetlerolly Assisletl Programs," 49
CFR part 24 mtlutling, but nM limned to iha following:
(a) The appli®nt unit atlequately inform eatli aRetlxtl p¢rsoo o(ihe benafiis.
pobues. and procetlurea proNdetl for In 49 CFR pad 24;
(b) The appllceM will provitle faV antl reasonable relocation payments and
assistance roquVeO Gy42 U.S.C. 4622, 4329, antl 4324; 49 CFR pert 24;
antl any applicable FTA prpretlures, 70 or fprfemllles, Indivitluala.
padnerehipa, wrporatlone or azswiafions eiaplsyetl as a result of any
prgeM finanwtl wits FTA assistance;
(c) The applicant will provide relocaden assistance programs offering the
ws desaibetl In 42 LLS.C. 4625 to suM tluplewtl famines,
Intlividuals, padnarships, wrooretlons Or asaodadpns in Me mann%
provided in 40 CFR pert 24 antl FTA Dmwtlures;
5}Y tam caamsmiNReaepamuaa PldP~ lp
FMeral SecE®9311 C¢Iti!®dppq gpa NNmnca -
Paye]aEIB
(tl) WN11n s resapbable tlme before tlleDlacement, IDs ppplican[ will make
available comparable replacement tlvrellinga tatlisplacetl families and
indNkuel9 as requvetl by 42 0.$.C. A626 (c) (3);
(e) The Appllcan[ will xhy out the relocebon process in such manners as b
pmvitla tlisplawd pereon with uniforms entl mnslsteM services, and will
make arellable replacement housing in Me same range t0 ell Olsplace
pempn regaNless of race, cplbr, raliglon, Or national Otlgln;
(ff In aeplltlnp real'pNpBM. the Aoollpnl will be m,itled rn eho ~.onm.r
(el
e~eaae as spedfletl In 42 U.S.C.4663 antl 4654, undersmndkg that
FTA w111 paNdpa[e in the ApDllceM'e trot of pmvltling those payments
antl tlfat assbtence fOrihe pmlept az required by 42 U.S.C. 4831;
(h) The Appllcent will axeate such amendmehis tbthlrtl pally wntrects antl
aubagreemenis financetl wYVI FTA asslatanm and BxOcete, Mnleh, entl
be b0untl by such etldigonal tlocumenk as FDA may tletennine
ceesary t0 effeduata Or implement the aaaurencas prcvH¢tl herein;
and
(i) TM Applipnt agrees to make Nma a6auronpes pad of or incorporate
them by roference IMO any ihiM parry centred w eubagreemeM, or arty
mendrreMS thereto, relatlng t0 any pmjed Flnancetl by Ffq invoMng
elOcellon or lantl apquiaiti0n antl provide In anyafteded Occumsnt that
these relOCa800 antl land acquisitlon proviaiona shell eupehede any
confllctlng provisions.
(]) W III comply, es a applicable, vNih prWiSbb O! the HafeF Ad, 5 U.S.C. i5o1
through 1508, end 7324 Nreuph ]326, which Imlt Me polttical acWltlee of
state and local aBmdas antl their OtflceR abtl employees whose pdndpal
empleymenl activities are finan Wtl in whole or pertwiM Fe08rel funds
Indutling a Federal loan, grant or cooDeragve agreemen( put does not apply
io s nonsuDervlsory emDbyu of a transit system (or of any other agency or
entity pedpmting relafatl ivnNOns) remlving FTA eseistanFa ro whom the
HBIOOI Art tlOes not otherwhe appy
(67 To extent ap011cable will cemptywfih the 08via-BBDdb Ad, ea amentleq 40
U.S.C.2]6a Yhreugh 2]Ba(]), the COpalantl Ad, es amentletl, i8 U.S.G. 6)4
entl 40 U.S.C. 2]BC, entl the ConireM Wprk HCUm and Safely 9tantlaMS Act,
as emended, 60 U.S.C. 391hrou0h 333 regaking labor sandaNs for
fetlemlly-assisted aubegraemanta.
(S) TO Ne eNaM appllWblB(will wmply with flood insu2nce purchase
requiremaMS M section 102(a) of the Flootl plaster ProtedlOn Act of 10]3,
as amended, 42 U.S.C. 4012a(a), which requires redDlents in a spedal Oootl
hanM area b peNtlpete In the program end to purchase flpotl insurance If
Ne total met al insurable conswdion antl acquisition is $10,000 or more.
(10) W III wmply will envlrenmentel standards that maybe presctlbed to
bnplemeni the folkrvdng Fetleal laws and exealive orders;
SFYI093 CUmmudty9mrymoboa &ogrw Il
Age ioll8 FMaal9ecem 5311 Certlfieedmrvod Arwwcee
(a) InsNUtlon of anrironmental quaky control measures under me National
EnvironmanY91 Policy AG of 1868, ee amantled, a2 U.6.L. 4321 et seq., antl
Executive ONer No. 11514, az amentletl, 42 LL3.C. a321 mW;
(b) NaifpdonW vidating fadilitles pgrsuent to Exemtive Ober Np. 11]3S,
a2 U.S.C. ]606 ppta
(c) Protedign cf wellentls pprsaanl m Execullte Ober No. 11990, 42 U.S.C.
4321 nWe;
(d) Evaluation a flood dazaMa In Opptlplaine In accoNena wiln F~asative
OMar 11900, 42 U.S.C. 4321 note;
(a) Assurance of project consistency wiN Me aDWwed 9te1e management
prog2m tlevelopetl untlerthe Coeatal Zone Management AG 19]2, as
ementlad, lB ILS.C. 1451 et seg.;
(f) Contormitp of Fatlerel adipns to Bete (Clean Alr) Implementation Plana
under section 1]8(c) if the Glean Air AG gf 1855, az amentletl, a2 U.S.C.
]x111 et seq.;
(g) Prolectipn of untlergmuntl source eftldndng water antler the Sale
Dtlnking Water Ad of t W4. as amentletl, 42 LLS.C. 300n e[ sap.;
(h) Pro[edlon of edtlangeretl speGea under the Endangered Species Ad a
19]3, as amentleQ 16 LL3.C, 1531 et sag, end;
(i) Envir0nmentalprotetlions for Federeltmnsd programs, Including, but nor
IMitetl to proledipns for a perk, reaeatlon area. or wildlife or watertewl
refuge of na0onal, stele or Ippal eigni8rance or land from a nisrmb site a
radarel, stale m local sigdgr ce used in a trensil pmjeG as r¢quiretl by
ae U.S.C. 303.
(11) Will Compywith the Wild antl Spenic RNere AG a 1968, as amentletl, l5
U S G t2]t et seq., relating m praectng pomporeras IN [he natipnal wild
and seadC Wars 9yelems.
(12) Will assist FTA in assuring compliance with xdion 106 of lne National
Hlsfodc Preservation Atl of 1856, as amended, 16 U.9.G.4]01, ExeWMe
Order No. 11583 (Identification and pmtedlpn of Mstorlc properlles). 18
119.C. 4]0 note, and Oe Archaeological and HlsWric Preservation Ad of
18]4, as amended, 1811.3 C. 488x-0 et seq.
(13) WII mrrply Wlth tae Leah Basetl Paint Poisoning Prevenlion AG, 42
U.S.G. 4801, wfiich prohihits the use of lead-basetl paim in umWNOn or
rchabilita8pn oI reeldence struaures.
(14) WIII rot tllapose of, mptl8y fne use of or Dhenge the krms athe real
Droperty title, or other interest in Pe silo and fadlides in which e
mnsbudlpn profeM supported witlt FTA assistance takes place without
permission and inaWGlon from Ne ewaNing agenq. WIII r¢wM the
Federal In4resY in the title of real property in ecoomanca wiN FTA
directives antl will Include a cotenant in the title of real pmpedy acquired in
wfiole or in part with Fetlerel assistance funds m assure npndlscdminatipn
dudn9 Ne useful Ige of the prpjaG.
(15) WIII comply witn Ffq repuiremants mnceming the dreM1ing. review, and
approval of mnslrudbn plans antl specNrelions m any mnaWtlion
project supportetl witM1 FTA assislenw. As requiretl by U.S. DOT
9PY2M3C®mvlh TSmewnemPmpem
12
FMgq Sxaw 53tI CeNGnaeasyygenuw,..s
Pege9oPt8
ryulailons,"Seismic 9afety,'49 CFR 41-11T(tl), before accepfing tlelivery
of any building flnancetl w'rfh FTA assistanw, It will obtain a cedificata of
wmpllence with the selemlc design an0 wngimdion requirement of 49
CFR part 4l.
(18J Will proNtle antl maintain competent and adequate enginaedng guDervision
at Me wpsWCtlon site of any pmiect suppodatl with FTA assismnw to
ensure that MC wmplete0 work pbhfolms vnth the approved plans or
spe~patlons and will furnish progress reports and ouch other informetlon
es may be required by FTA or Me 9tete.
(1]) WIII wmply with the National Research Atl Pub. L 93-346, July 12, t9T4,
as amended, re0ertllnp Ne prvfedlon of human subject inwlved in
eaasrch, tlevelopmeM and rolerptl ecavitles suppprtW by the FTA
aealatance.
(1B) WIIlwmpry sorb the LabgaNry Animal Welfare Adof 1986, as amentled.
] U.GC. 2131 et seq., peHalning b Ma care, hantlling, end treatment of
warm blooded animals Mld for research, teaching or oMBracfMtles
suPPOrtetl by FTA asslMance.
(19) Will have pertormetl the required finandal and wmpdanw autlh in
accordance wiM the Single AYdhALt Amendment of 1980. 31 U.S.C. ]501
e[ seq., antl OMe Cvcular No. A-133, "AUtliU of Staten, Local
GovemmeMS, and Non-Profit Oryanrsetions antl Department of
T2nsp0lr8fbn pTVislOna MOMS q-033 CpTpNIw $UppemenL Mamh
2000; antl
(20) W uI wmpyvaM ell applicable requiremenn el all oNer Federal laws,
- eoa:Mive aMers, regularons, antl pclities governing ihepmjed.
LOBBYING CERTIFICATION REDDIRED FOR EACH APPLICATION EXCEEDING
igg Oooa
An Applleantthn submit en epplfeatbn /or FTA geeiatanw gxcgetlln0 E1o0,000
must prpvitle [he following certiflghon. NCDOT may nM provltle FTA
eeeiatenw for an applira8an ezceetlin8 8108,000 until the Applicant prpvitles
(his cartlgcdllpn shown by seleWng Category II.
A. Aa required by U.S. DOT regulations, "New ResMdions an Lobbying," at 49 CFR
20.1 f O,Ae Appllganfs autltohzetl reprmanlatNa wdifles to the bell of his or her
knowletlge and belief Mat far each application for a Federal assistanw exweding
EtD0,000: '
1. NO Fetlerel appmpriafed Nnda have been paid arwill be paid, by or on bahatt M
the AppllwnY, to any person {or iMluendng or atlempting to InManw an oPowr or
employee o{ erry egenpy, a Member of Congress, en officeror employee of
Congress, or en employee o{ a Member M Con0reas in wnnectlpn wlM iha
awaking of any Fedeml assistance or Me etlensieq continuation, renewal,
amendment, or motlHwtlon M any Fetlerel aealafenw agreement.
SFY 2W3 CwmnwiNTrampamtion NeBan
FNnd Sectiw5311Co-tifie¢p¢s ml.3.~aaeee 13
PaSe tD o[ta
2. If any funds ether Man Fetlerel appropnaletl luntls have been paitl wwill be paid
many person for Influencing or attempting m influence en offgr or employee of
any agency, a Member of Congress, an officer or empbyee of Congress, oran
employes of a Member of Congress In corer Lion with any application m FTq tar
Federal assstance, IM1e Applicant assures that h will wmplem antl submlHM1e
SlantlaN Fomt-LLL, "DisGceure Fortn m Repod Lobbying," indutling information
required byMe forms InsW cti[na, which maybe amentled ie omit sudl
information a3 pennigetl by 31, U.S.C. 1352.
B. The Applinnt ulweretands Nat Mle certifiwtlon le a material represenla6on of
fad upon which reliance le placetl and flat submission 0t Nia ceriifcation is a
prerequisite for provitling. Fetlerel assistance roc a tranaadion covered by 3t
U.$. C. 1352, Tha Applicant 4150 UndeRlend3 that any paROn Wbp fails Ip fa e
requiretl CBNficafron shall be subject to a ciNl penaky of nal less Nan $10,000
antl riot more than $100,000 foreatll such f~ilure-
IIL C rt'H [I Pert' ' [h EH cts f th P ' tt Prtvare T b
Comoanlea
An applicant that Is a local govsrnmem seeking assistance antler qg Ub.C.
chapter 53 to e[qulre property oran Interest in propedy of a prNate mass
transpodaUOn company er opamta moos traraperWion equipment or a facility in
[ompstition with or In etltlltlon to transportation service provided by en existing
mass transportation company must provitla the fallowing certigcatlon. FTA may
not award Federal assistance until the Applicant provitles this certiFleMlon by
selecting Category III en Me signature page.
As required by 49 U.$.C. 5323(af(17, the Applicant certifies Nat baipre I[ aryvires
property a an Interest In property of a Drivata mess 12nsporatipn company or operates
ss Vanspprtation egWpmant or a tacilib in mmpeiitipn wiM or In addltlon m
irensportetl0n service provided Cyan existing mess transportatbn tympany it has or will
have:
A. Fpuntl that Ne assisrance is essential to mhying out a program o! projects as
determined Cy tM plans antl pragrema of the metropolitan plannlrpT oganimtion;
B. ProWtlatl for Ne parddpafion of Drtvate mass transportation wmpanles m Me
maximum cdenf feedCle:
C. Paid or will payjust Cempbmatpn antler slate er local lewmapdvate maze
trensportsaon TAmpanyfor its frencM1ises er propertb apqulreq
O. The asNStence falls wiMin the labor standards c0mpllanca requiremenis of 69
U.S.C. 5333(x) and 5333(6).
N. PUB pRl ERTIFICATIO EOUIRE ACAPRAL PRQIE TH
1YILL SIIRSTANT gLLY AFFECTACO OR $ SERVICE
s>•rzop3 c,pnm,mynaaaFwRagne.o®am L
Page 11 of lB Pcdeml Sectim5311 CapOceYe®mEgas,ueprp
MAIp11caM Seeking fetlerel asslMance untlar48 U.S.C. chapter 59 for capital
sasistenee or assistvnea that wlll substantially aflaet a wmmunlry or its henelt
service Onenatl antler enetnar progrem must proHtle the follgwing [ertiRmli0n.
NCOOT may net award such aaslstance until the App110ant provltlea Nis
eereeeatlon 6hown by SSlaarng Calsgory N.
A9 require0 by4B U.B.C. 5323(b), aAe Appllrant ceMfes that it has, or before
aubmibing its epplicagcn, will have:
A. Pmvitletl adequate oppOMniryfore public hearing wtlh adequate prior notice
vfiltlr was published in a newspaper of generel dralation N the geographic
ereaf0 ba semtl;
B. Heltl that hearing antl pvNOetl a ir8nccript f0 NCODT, unless no one wah a
signierant econemiq sgdal, orendrenmental interest requeakaheadng;
C. Cgneldered the eeLingmic. 9eC10. and EnVmnmepta ¢Reefs Cf ihs prole[!; antl
O. Oetennined ihM the pmjed Is conalefent wkh ORicial plan3 for developing the
area.
V. CERTIFIC TI WARO OEL WS REpUIREO FO
ACLIOISITION OF ROLLINO BTOCK
M Appllcent seeking FTA aenlWnce to purchaze rolling stock must make the
following certification. NCUCT mry not proNtle FfA assistance far rolling stock
scqul6ttlons until Ole AppllcaM provltles this e¢RIACaBOn shown by selecting
Catagery V.
Pa requiretl by 4B U.B.C. 5323 antl lmplemedting FTA et 49 CFR 563.T, the Applicant
certiFlea that h will compy wiVl iha requirements of 4g CFR part 663 in fhe nurse Of
purchasing revenue 6ervife mllinB clock. Among Olher Ihinga, the Applkant will
gontlud or cause Ib be bantlucletl fhe prnrn'betl pre-aweM end poatEelNary revkws.
end will maintain On file the o3dNcationa requlretl by 4B CFR PART fi63, subpads B, C
end D.
VI. BU~QeTINO CERTIFlCATION REOUIREO FOR NEWB
M Applimn! aeetlng FTAasslamncete esquire new buaee must make fhe
bllewing certification. NCOOT may not provltle FTA asslelenea fqr the
agqulsNlOn of new buses uMll the ApplloaM provitles fbls eertMemlOn shown by
sekdin9 Category VI.
As requiretl by FTA regulatlOns,"BUS Testlng,"et 49 CFR 885.]. fhe Applipnt certif s
that before expentling any Federal assistance to acpuire the Bnit bus of any new Gus
model or any bus mOdol wiU a major charge In coMguretion er cemponeMS (as
described in 4B CFR pert 555J: (A) The modal of the bue will have been tested at a Due
fesllnq fedlity approvetl by FTA; end (B) It wgl have received a mpy of the tegt repOd
preparetl on Ihebua nwtlel. '.
VII. CHARTER BUE AGREEMfiNT
SFY 20m Covamplry Twvprpdpp Pm&am
Faknl Secppn 5311 GNBCetiepe apApamusaeer 15
Page b o(IB
An Appllcant eBeking FTA asElstance t0 azqulre otgPorate tranapertaUOn
equipment orfeulNiae azqulretl with Federal assistance auth0dzetl by 99 U.3,C.
chapter 5301 T1t1e 23 U.S.Q (axwM{BUS.C. 5910)must enter Into the following
charter aeMCe agreement. NLDOT may rent provide FFA assistance Par these
prOfecfe until the Applicant azcepta NIB agreement by salacgng Category VII.
A. As requlretl by q9 U.S.C. 5323(tl) end FTA re0uladone, "Lhaner Serdm,~ a149
CFR 609.7, the Applicant agrees that it antl Its redpients will:
(1) Previtle charter serum that 0509 equipment or fadities acquired µ11h Federal
assisfenm authOtlzed for /9 U.S.L. 530>, 5308, or 5311, or Tid023 U.3.C., OnN to Ore
aslant that there are no private Mauer serum oparatom willing end able to provide Ma
charter service the[ It or Its recipients tleelre to prOVMe, unless one a more of the
exwpgons in 49 LFR 609.9 applies, and
(2J Comply with the provisions M d8 CFft pad 804 babre they provide eny charter
aervim using equipment or lacilifies acquired wiP Federal esaiafanw aulhorimtl for
the above slaWtes.
B. Tha Applimnl undaratenOS that the regdremants Or49 CFR pert 604 will appN m any
Mader servim prpNtleq Yne definitions in 49 CFR pan 604 apDNto this agreement,
and violation M tnia agreement may require wrrective measures and d1e imp0sttlon M
penalfiec, ladutlirrg debarment from me receipt of fuller Federal assistance for
transpoRatlon.
VIII. 3CHOOL TRANSPORTATION AGREEMENT
An Applicant seeking FTAaaslelance re acquire or ocerefe tmnsp0rlatlon
facilties and equlpmen[ acqubetl with F,Meral asalstanee aMhorized by 49,
U.3.C. Chapter 53, mual agree as iollowa. NCOOT may npl prOVitle FTA
assistance for trensporlnti0n facilities until tqe Appllcant Bccepta this
ABreameM by sele0ting Caegory Vlll.
A As requiretl by U.S. OOT 49 U.S.O 5323(p and FTA regulatbm,"3MO018ua
Operatlpns; at 49 CFR 605.14, Ne Applicant agrees that it and ell 9e recipbnls will:
(t) Engega in school bus opera60ns In COmpeliggn wilM1 private sMOOlirenspOrbtion
operemrs only to the eHenl permllled by 48 V.S.C. 5323(Q, antl implementing
regulatlona, antl
(2) CompN with the regwramanta qt 49 CFR pad 605 before provitlin0 arty sMool
trenspprtatlpn using equlpmen[ m redlitias arquhed wIN Fetle+al aealelanm aumonzetl
by 49 U.S.C. Mapter 53 or Title 23 U.S.C. awardetl by FTA for transportation projects.
3, The Appticent dntleRtentls that the reONremen6 of 49 LFR paR 605 will appN to eny
school Varuportation it prwitles, the tlegnigone of 4B LFR pan 605 appN b this sMOOI
tranapoMdon agreement antl a violation oRhis agreement may require comedNe
assures antl the imposition of psnellies, inelu0ing tlebnrmant fmm Me reeeipt or
1uMer Federal essisaance for ma~~trenspMatbn.
9FY]n03 Ca®miry "Ravvpmparn PmgiO
Pagel3aft6 P°tlael9atiw 5311 Cen~ceamravtlgssivavicee 1
DC CERTIFIL XRE cp FOR TXE WARP OF FTA A6SBItTF TO AN
~PIJCANT GRITS DEMANp 3 NS BERN E
Ah epplioantseeking Fetlerel xeiatance to support its tlemantl reeppnsiva
cervix mYat pmvitle tM1a fellawl0g certlfgflpn. NCOOT may not make a grant of
FTA assistance tllrarAly[o an ApplleaM to suDDOrt Its-0emantl rospondve xrvie0
unW the Applicant provltles Mls wtlMwtion shown by selecting Lnt¢gpry I%.
As requVad by US. DOT ro9uletlOns,'Transpodadpn 9erviwsfor ind'rviduele w¢M1
Dleabllitiaa (qpA), et 49 CFR 3T.T/, Me Applicant cemfes that its Eamand responsive
service offeretl tp persons wish disahlil0es, intluding persons who use wheelchairs, is
equivalent [e the level and queliry IN earvlx ogeretl f0 persona witheul tlicabilMas.
When viewad'm im endrery, Its seMce for persons with tliaebllXlas ie provltled in Me
mostlntegm4tl setting feaslEle entl is equivaient with respam ro: (t)response time;
(2) fares; (3) ge0grephic aernce area; (4) hours and tleya ofxMCe; (5) restrkiipna on
Mp pumpse; (6) availability M imomrstlon entl reaervatien mpabiRy; entl p)
cvnmmints on wpetlryor service evallebility.
X 3UBSTANCE ABUSE CERTIFICATIONS
If the Applicant is requlretl by Fetlml regulations m provitle the following
substance abuse certlliwtlons, NCOOT mry not prpvitle FTA assistanx until en
Applicant has selaMetl CalegoryK
A. Alwhol Tea'no CSrdflrapan
As required by FTA reguladons,'Prevemipn of Alwhol Misuse in Transit
Opereeona,"Yi 99 CFR 655, iha Applicent wdRiae Mat tt has esbbliahe0 ens
Implemented an algphpl misuse prevention pragmm in wmplianw v4M the
requirements of 49 CFR Pens 40 end 655; entl tripe Applicant hae employees
regulated by Me Fetlerel Rairoatl Atlminis[rei'mn (FRA), the Appliwni also
wgdies Nat p has for Nox emplpyrees an alwhol misuse preven[on progmm
Ihet cempllea with Me requirements of FPA's regulatl00s, "Lpntrd of Alwhpl and
Omg Use;' 49 CFR pan 218.
B. And-DNp Pogram Certifwtipn
Ae mqulretl by FTA regulsaons, "Prevention of PmhibitOtl Omg Ux in Transit
OpereSOns;' IN 49 CFR Pans 49 and 655, the Applicant ceRlflea Ihat It has
eetebllehed entl implemedUtl an antidrug program, and has wntlucted employee
paining wmptyilm whh Me requirements of 48 CFR Paris 40 and 665; and'rfihe
Applicant hae employees regulated by FRA, Ma Applinm also cetllFes Mat it has
for Max employees an anti-tlre9 pro9rem that wmplies Mm Me requiremen6 of
FRA's rogWa0ons; "Control of Alwhol and Drug Use," 49 CFR pert 219.
%I. CERTIFICATION FO THE ACLESS AND REV pR
Ea0h ApDllgant far Job Access entl Reverse Commute Program Assistance
auehorizetl for Sentian 0817 Mths Transportation Equity AIX for the 21°' CenWry
must prevMe the following xNFlOrtlens m wnnectipn with Rs appli0agon.
snzop, coa~w;ryT„a,panadmFm®.m
Pb la CIS Federal seryvv 5311 Catifieadwaand Meuaexee
NCDDT may net pravitla FTA aseiefance until an Applicant has selectee
Ca[e9ary XL
The gppriwnt ¢emfiaa ear
1. Itwlll ensure that fde eldetly antl handiceDpetl persona, a any Derson presenting
e Metlicera mrtl Issued b himseN or hem¢N under title II or title XVIII Mihe gocial
Sewdty Act (42 0.g.C. 0g1 et seq. or42 U.g.C. 1395 et seq.), will be charged
duang ndn-peak hours for trenspopaticn using or invoMng a fadliry or equipment
9nanmtl In party with Fetleral azsistance authorizetl for gectlon 3937 of Ne
Transportation Equiy An for the 21"Century.
2. II will ties rompetltive procurement (as Oe}Ined or apDrovetl by NCDDT antl FTA).
It will rapt mntlud a procurement using exduslDnary or tllscaminatory
spedflmtions, antl It will comply will appli®hle Buy America laws In wrtying oW
e pmwremeni.
3. It hee complied orwill comply wiN the requirements or before submiifinp Ne
application it will make avatlehle to the general public Informatim on amounts
available for the Job Access antl Reverse Commute Gmnl Pmgram, projena It
proposes m undertake whh tllwe funtls and dewlap a process b solidi end
m eider public wmmen5 regartling fare Irrwasea antl major reductions of
Vansportation services.
4. Itwill rant use Fetleral a5aisr2nce ro Onance [ha met of leasing any capital asset
until $ perl`orms ralculaiions tlempnstratlng Thal leasing the capital asset would be
more rosneRaNw Wan purchasing or mnstmeting a similar asset.
%II. ADDITIONAL CERTIFICATID SAND ASSUR
NONDRBANIEED AREA FORMUL PR R W
Each aubrsdplent of the FTA Formula Assislanm Pmgram ror nonurharraled
Areas must provltle the fpllowing eeyifisatlona antl assurances. Accortlingly,
NCOOT may not aware any Fetleral aaeiatence until Ne Applicant prpvlae3 these
mrtmcatlpns and aeaurancea.
A. The Pyplimnt has orwill haw the necessary legal, tinendN, ana manageaal
cepabiliry to epPIY far, rewiw end diabuma federal assisranm aNhorized for 49
U.S.C. 5311 funds; sntl tp Implement ana manage Ne prpjed.
B. The aDDlicaM has sumciant nonfetlerel /ands that have been w will be mmmlRetl fp
provide the required Imal share.
c. The ApWimnt bas, or will haw by Ue time of delivery, SuRldent Ponds to operate
antl maintain the whitles end equipme0i purchazsd with Federal assistance
authadzed for this prolen.
sPyapp.3 ~~Y'lyav*Fmedwpmgemp
Pepe 15 of 16 PNael SectiW 53110.ttifmtiom ®tlgfemevca
o. 1Te Applicant, w We maximum extent feeaNle, cooMinated wiN other
irensppnetign provitlem antl usere, indutling soda) service dgendes euthorizetl w
pOf6hdaa t2nSit S¢NI®.
E. The pppliwnt 4 In compgancs witd all appli®hle dvil dgh4 requimmenis, antl nsa
signed Ne Nontlisviminagon Aasurence.
F. The ADDllcentwill epmpywifh applimble requitaman4 of LL5. DOT regulatione on
padidpation of dieadvandB?d business enterprises in V.S. DOT Drograms.
G. The Applibant has pravitletl an Asauren® of Npntliscnminatign on Ne Basis of
Oisabiliry, az set wrih In the Cerdfmtion and Assurances requiretl M eadt
applicant for GTA assiswlrce. If npnecceealble vehicles are being purchasetl far
se by a entity In tlemend responsiue seMce for Vie generel public, the applicant
hoe submittetl a CerliFcale of Equivalent 9eMce, which elates Na[whan viewed In
i4 enEreiy, the puDllc entlrys dementl responsive seMces offered to persons with
tll6abllnlee, Including persons mho YSB whealchaire, meets the s4ndaN of
equivaBnt seMce as set fotlh b 40 CFR section 3]>] (c).
H The Applicant hoe compllatl vdlM1 Na treMit employee protective provlslona of 9g
uS-0. 6333(D), by once of Ne fallowln8 acdpre: (t) signing the $pedal Warranty
for Ne Ncnurbanized Area Formub Program. (]) agreeing to alwmatlve
ompamble amngeman4appreve0 DY we Oepatlment of Leboq or (3) ohtaining
a waiverfrdm DOL; antl Ne NCDOT has certlgetl the Appliwni§ wmpllanre to
DOL.
I. The Applicent has ceNFled that it will comply wiN 49 CFR pad 804 in the povision
of any charter service provided w¢h equlpmani or fadltlles acquired wim FTA
assistance, and will also comply wiN applicable pmvislons of 49 CFR pert 605
pertaining w school o-amporbtion operations.
J. The Applicant has submined an applicablewrdfmtlons and assurances arrcmly
required, indutling bu[ no[ liml(a0 to a ceMbatlgn Net I4 prawrements -antl
precuremenl system vAll comply wiN all applicable rcquiremenis impoeetl by
FetlOrel laws, exewlive okere, qr regulation and Ne requlremen4 of FTA Circular
4220.1D.'Thlm Pady COnirecdng Requlremenis; antl purer Implementing
requirements FTA may issue; a cediFlgiion Nat it has paid orwill payjust
ompensatlpn under slate or Iccel ~ to each prNete mess traneporNiion -
wmparrycar ilS franchl59 or preperry aoauiretl antler Ne pmjed; a
nonpmcurement suspension antl tlebannem cen1F¢edon; a preawak and Dost-
tleliveryreview ceralcatipn: once alobbying ceNficafion fir ucn application
exwatling $100,000_
FYY003 COmmunlty TransporlaOOn Program (CTP)Gnn[Applieation 19
Jw 2002- "a^nxm mm-o.e
Y June 200]
FART I ~ADMINISiRATNE ANp EMPLOYEE DEVELOPMENT 6YOCEf80MM
Legal Name of SUbredpienC Dlanga LOUnry
SubraciplenCS Fetlenl Taxpayer IdonSOwtlon Number. 56£000-32]
(Naf-forfroRls need to aubmita copy olmeir lRS CaMCMa)
Period of Perfortnanw: July 1, 2002-June 30. 2003
NCDOT
I. TOml Prgecl Exoentlitums $Epyea~tl APWevnd
(NCDOT Maximum Parlidpa0on Amounts)
AtlminislmOVe Expenses $ 161,AO g 0
Employee Development Expenses 3,idg $ 0
Tobl 8 166,915 8 0
-L Funding (DO not complete ibla section)
Tpfaf Fetlanl NO[N)T Leal
100% 00X SY. 15X
Atlminlsbafion 0 0 0
D
100% 05X OY. 15X
Empleyea
Development 0 0 0 0
'~otal FUntling g0 $D $0 g0
FY2003 DTP APPfce0°^ t vtennm
FY3A63 cpmmnniy iren.peMeSen Pmgmm (LTP)cantgppsaangn sB
open wrz aacr-aw
PROPOSED PR0.IECT BUDGET
AOMINISTRgTIYE EXPENSES (Oep1, a63tf
auenoW.m: Orange CO0nb
NcoOT
Oblaal Marmara
Gotle
Tifle PartlclPallon
_ Tofel Cpe[ (ebpu¢onryj
ue ~ saMNes ana wages
121 FulWme employee9 4.afq $
IYl W¢Nme
125 paR-time (RRi~2a banelib) 60,316
136 Tempwery and part-Brae (remiwana nanaPas)
12] Lon9a5'Iry 1,aa8
Suptogl9aleflm: $1Ca,280 0
180 - Ftlnq Beneflta
161. Sotial sa5urity snlnbNlon Q.85%af loRl atlenea) T,BT1 0
182 ReWemenl mnlnbwon (f x _%).
ma,z9o x a~g%
~ s.egs
183 Hos Ital1za110n lnsumnw(
.X 13 X
Xempl.)
_
290 X 3.SS
~ J,WA
tea Olaebllity inwarrw ($
t2x_xanpy
~
y0 x
~~ o
165 Unemployment aompensatipn '
165 Workers pnpenaellon
a
ifi9 ONe[
LXe, Cenral arE a01 K@516660/mo. 1,688
3ubbtal Fnnge: 1,880 SO
TOTAL 9ALARYBFRINGE: 8128,260 50
taD ~ Prgfe¢alorMl Servlcez
t9l A¢wunfinB
tsz Laaal
1BS Maregememmnaunam cmtrePt (eamin. onlvl s.9oe
1e6 Drug aamnal Taeaiy Contract
1sT Drvg aacphpl Tea4(mu. panlagtlon per teat arcoM1al830,ame EeO)
186 Medwl ReNew Ofi
100 OMx spanian l(anaietign of OPTbmcbure, Express ernaauie e¢. 4,350
PrwMe % U employ>zs m test ppp7.
200 ~ euPPllea ma Ma1N1618
211 Janlbnal supplies '350
z91 spalal propam molenw Ieauwtwnel)
z9x Auaio vlauel ana rlxary aupp6ea
z6t .Draw supvllea one malenele t ago
zet arpmnalmlrerf FUmax nlMrs
291 LPmpNer aupplg6 z50
FV9IIlIA (:TP atlminicamaiv. Rrrtlnal Panolnli
AOMINISIRATNE IXpEN3E3 (pgPL 4621) 2t
NCOOT
Objec[ Mazimum
LoEe TIW Participation
T talc ly
900 ~ Trvvel anE TanapeMtion (oMei Man emp/oyaF Eweb
men
31t p
N
Tra. l(Anticipetetl hips NCDOT Cmfeience
NCPTA meetin
,
gs 153p
NCDOT hain'vgg
312 Travel gu0.sisknre
314 VehHe rengl(Mes not lntlade ve4ides fnr
govkin0 contradetl servlre9( 100g
310 - Cemmunlmflen¢
341 TelepOane seMw(IpdYdes modem antl lullnes) 6
322
Infemel5arvice Provitler Fea (Ngma ) CW
' (mar~mam SZSmmnm, Mr ermu&mlalms3oo)
re a wng tlmtarlca m dial m mro2
923 comolneO Service Fce (exdugiveNceJl phone er4me)
325 POBYeOe
330 - Vtillfbe
331 Elec4lClly
332 Fuel oil
333 NeWnl Oaa
334 Wamr
335 Sever
33B Tian cdlaction
33) Singly¢¢mbinetl utility bill
339 OMer
340 - PrtNIn98ne Bintling
361 Pfin5n0 antlrepWUHlm 1W0
3d5 Otlwc
350 ~ RBphim antl Melnbeanw
355 Ollie and remgMr a'NlpnwM
3fi] CommaniraYms apuipmmt
359 OII'pr.
3%e ~ AtlvaNainplPromotion
3]1 ANrkelinp lppld atlvMlsemenp, melrceEng 6~m
s16
)
.
,
O
l 23p0
esu
be: Nearspbper%ekvisimh®bloprvmationa'r10 d vd
3Ti Romolimal xema
oamoa:
3T3 OMr. DMV VnNOma 9400
f00 ~ CempNer SUpporl3ervlces(ronVamam
361 Conputxpragmpunmg semcas
382
Lom
Nr 61(p
eupportXaMnical eeaubnce
W
194 - OMaf Servleea
3g1 Legal edvallain0
FY2003 CTP gtlminis121ive Budgef Papa J M a
ApxIN18IRgTIVE FJyEN3ES (pepL 0931)
:z
NLbOT
Objec< Maximum
Gotle Tile ~ Partklpdtion
TpfalC ! I
3da Limning esrvkea
396 Me
na0emen(servkas (spntlacleE transit eysRm mOmUMmi ervlcea)
nz
390 ~
3 IIb wMCBS
399 Omer.
d10 ~ Renml ei RealPnpar(y pnGUde mpy of artentlmvugrMmen[)
d13 Renl NbpAEing
-~~ x tz g
dt3 Rent MOtfieae
X t3 g
d1B ONx:
d30 ~ Waa Of Equipmvnt
d3t Leefle of ReprotlucXOn yuTmen[ 1,400
d3z tewe otryvewmer analW qulaga meter
d33 (Eaaemcpmmwimwns equipmm(gndaaea ream, mete nn~ana
ent.nnael
4as Diner
d00 ~ Swlw and MaMtenenm LPnlRpts
4d1 Communkations equipment tdgg
a42 Off¢eGUlpment
da3 Reprpducupn equipm.m
M5 Computer &luipment
a69 Oma FIR Balinguiflben 559
aw . mauranee ane ppnamg
451 prop.rty ane ganasu®bait' (goes npunauaevaMOle Naunncel
o5d PlakasbnallmbilN~
d95 9psiel r¢blliliez
:Sb - Inairecwpea
491 c
entrd'vernpee lS x
x)
-
_
-
~
~
' o
~ ~pv mmaat
rewm
(
YaddAetl iMirwa mNplerREOUIREO)
[s.mmct par Pe
ryat(ffi9)45d-6p28gppetryQtlMState.z,ue if you Anae quesfigna re08M Vg eenkal service)
J9p ~ OMar Fixcd Lnaf9w
401 Dues ana subadipEana Tom.
Iprscribe: NCPTN membeRM1ip800; Tansn Naws190
'
~ TOTAL OTXER MMINISTRpTIVE ExpENSE9: 635,510 So
I
TOTAL ADMINI97RATIVE EXPENSE&: StO1,n0 30
Pvo nm rrw ad.~~..:.n..n... e~.n_.. _ _ ..
F1@0p3 Community Tranaporletbn Program (LTih Grantgppppti0n
aro(an xn: -om
PROPOSED PROJECT HOOGET oa
9ALGRY qNp WgGE pETAIL-ppMlNl$TRATION
SuCwvpvrn[ ~__ _
Salary in
Fulltlme NCOpT
Oblecl M®mum
Cntle Ponlllan TNe E9ulwlenl PRI%) BuEpMtl IyN'gpalian
121
Tmnsppllntkn 5upervfmr Na.
1 IFTE Trans pmmmt rydFUnary(
121
BYlin9 Clerk $
' 33,6)8 1Po%$ 33,9]9
125
OPT Di for I 26.980 )59: 18,)35
125
6utl9et Olhgr 1
1 -9,590 40% 91,632
12]
IongeWty 45,966 4p% i8i366
3.621
t m6
0
TGTAL SALpRYB WAGE $f 06,190
FV2003 SALARY WAGE GETAIL
FYIDM Cemmunily TrerupP~hxon Proprzm (OTP( GnMgpplieaUOn
26
Rolaaww: WtY~ Wa
PROPOSED PROJECT eUOGET
EMPLOYEE pEVELOPMEHT EXPENSES (Dept 45251
Subw<I}ane Orange Geunty -
xtoor
oel.Pl Maxlmwm.
Talal PaxldPSllon
59P - OIM1er Services
395 irBlnmg-emplayee e0umtbn e%penxs. Sahtyanplol benstwXallon- 3,145
relateE training fw employees orvoluMea2. Fypensn indu0e
regbheVaNWi4ory mlleaea, lotlging, and meal. Oeaplb¢:
uon«me.
P
tl
TOTAL EMPLOYEE DEVELOPMENT EYpEwBEB: S 9.iCb $ 0
FV9110A ClP FMPI l1YFF 11F1/FI /1PAICAT eI Ir11:MT o......~
Pvzooi crn APPmtim
Nmanvdiw o![IMenrmEiug
Pege 10
TRANS^!DWG
ffMOH)
For
North Cerolioa Deparwem of Traveponeam
Pub4c T~aporlatim Divimoa
Commawy Tnuepottaticn Program (CI'P)
Belwxa
OR yYGE CYntu'1'v PC C1tL POR'IATIOf,,
Namc ofLocal Cmwurtiry Traoaporretim $yamm
ORAN• C ~ Den+nn f5 S
OR eNOEC H~~
ORAN• COONTY DE ^N CMC
ORANG c0 y( ~,H
4RANGE ENI'F1lPRSE,
Name(e) of Area $h¢Re[N/
Vautimal Wohafioq
Cowry of ORANGE
2
Pv z66z crP nPPCemw
Mwmnod.w otUvdenmtlivg
Pegell
~ESSEIH ]HAT
WHEREAS, Governor Jamce B. Hum, fr. iasuW Execattve ordn Na. 29 m
-eccmba 19'!d which ivitived a statewide effortiv North Canlim m vtilis
o-ansportaM1OV remusa is Ne molt tact effective averma.
WFIEREAS, subamumdy, the North Cantina-epamnma ofTrawportation
(NCDoT) edopfed a policyaeSViring a locally endcraed and uaplemmted Community
Tmmportatiw Services Plm(CTSP)paiorm rcceivivg funds miler NCDOT admiwarered
programs, smh as Section 16; Section 18; Elderly and Disabled T~maporutiov
Assisrmce Program [EDTAP) em the Human Services Traspmtetim Mmagmamt
(HSTNt) Pmgmm.
WHEREAS, Admirdahatlve, opaetivg, etW capital fulls as available NrcuBh '
Nc NC-aT Ppblic Trmaporta[im Dividon (PTD) for Ne wordirsfiov of Community
Tamaportadov Progama Nat demonetnm a higp level ofceordivaticv among a group of
core Hvmm Service egmcice, other agencies aatl cannnmury argm'vaROVa Nat elan m
participate iv thelocal o-avaportatim syatmnto mce[Ne demavdeo(tbe Community's
vavapprtetiov needs. Care egmcies ivclude: lacil -memnma of5aciel Services, Aging
Services, Asa Mental Health Progvq Sheltared/voceticval Wmbhop soil HealN
[xpemnmt.
sectiov I
It is hereby agrccd that fhe
ORANGE COUNT Y Pi1BLIC TR NCPORTATION
_ 9yat®Name
ORe~Y E
Cowry Nmne
Q C n Dm f5 - a15 Orenee , NHe.IhDeot
Carc Agency kl Core ABmcY k2
o c n m-cwanam e t xe t
Core Agmry k3 Core Agwcy k4
OrmeeDrm¢e Fmerori~46,..~tmrated Q ry
a¢e County NmdS Pro
Cwe Agmry k5 _ ONm Agmcie; Org., Hc.
PY zao3 rnAPPha,mv
MnnmvAm of Uvtlemm~dmg
Page l2
m Ccopgedov with the NCDOT Public Tmnsparurion lNvidov will panigpa[e b me
Colnmuviry Trmaportadav Program (CTP) with Ne wdaataoding of Ne fodoving
resposuibi4tlea and mtlmildvgs as relamd iv the following Paragraphs:
1. All COre egmtiee rm~s[ecdvelY°°ardwfed their climtvmaportedav veeds avd
ra Dorcas a1 the highest level ofsideshmivg aM colt shasingpoaeible through the
1 cal commwity lmvspmlelio¢ sYStmt;
2. Core agencies may have aimmona when s®eofNeu naospottedon veale will be
me[ outaida Ne coordinaz d comrmmiry paruporteeon ryssQO baause ¢ iam°re toss
effadva. Hawevm, wary eRm[ehaRbe madebydae core agmrieemimme tba[she
coordiwmd eyvlem ryas m opportuviry to welvate tte coats a£shese eervicea oursde
IAeir rye4m m comPam fu11Y allacet~ ms¢;
3. Nlosier agencies and misvmmiry orgaviiadons wshe service area should be
mcmlmged m odn...lhe community tsmeponatioa syasem eo se m inareaee
appornmides for moresideehans~erW coat abasing
a. I1ae local Cortuuuviry ]yanpPOrtapou 6avice Plev shall be updatedpttiodicelly (az a
mivbuam, mmeallY) m reflect chavges iv agency PardciPetlon. and these changes will
be woNinated with dm NCD°T Publie Trampoaladon lNvi®ov end We 1od
commsmitysraoaportmion eavia°rY board. llpm wmpledav orhy ad parries, this
Memomvdum ofttodasta°ding will ace as ea afficief eddwdsm to 0e local
CTSP.
5. CTP fiends are to be used exclusivelym a451s1in flouting m4aiais[sadvq operauvg,
and capitil Deeds ofNe CommmdN Tsanapmtation System, inwhieh the avmwt of
fuvding 'U based an Uw twat md/ortype ofsmice provided (i.e.RmetGmerd
]IDbgr„ EvgWymem Asalesmce, em.J
x)
6. All Ponies wevatmd Nat i[PTD determines Naz m~e or male core ageaciwumt
P3rOerPalIDg W tbC C°oMmalM aYmm Wbpn 111E Syaf¢m COnld Plovlde It 0°2 C°91
effxdvely, then CTP flmde will be withheld uvtll wesecdve action hat be®1ak®by
Me core agmry(Iav7.
FY 2WJ CTP Appliueoa
Mcmimnmvn of Uvdnsuntling
Psge l]
Settlov R
ID Wima%s Whereof, the pmpes oftlUs Memmwdum ofVndas~ending has been
emheez dby appropdaw mW propare%olutiona ao vgnthe game, DincMr of local
Commmuty Tranaportatiw system, Director oftbe Cowry- paxhnmt of5ociel
Service%, Dvecwr ofthe Cowry Health DepmwrnS Dirxwr of IaW Agivg Services,
Director oFeLe¢Mmtal Ha+IN Progwa, nirecmrof ShelteredNOCatlwal WorkeMpa,
Comry Menage, and the Cheiryeew oFthe Icrai HOad of Cowry Cormvissionere thi%
~J'1 tlay of 2
mesa ~Hy~ C ~dT nspo Marton 9yetem ih'reoror
1 ~
HY: Gda2r
Wimesa Dhecmrof
Cmmry Depazament ofSociat Services
Br:
Wimwa Direcwr of
~ / ' Cowry Health Depawcn%
~~~LK 1~Z' Hy:
wamegs ~~•~ Dirxmr £
cal fg&io6 Smrces
Hy:
Area.MmW Halm Ftoea%n
Hr
DseROr of
ShelmrodNOCatiowl Wockahnp
(seal) Clot Cawry Mmaga
Chair, HoaM of Cawry Cmwie®ma%
r.a~~ ,~p~ ,,,. ~rma~~ ~ Ar,va~
SFY 2602-2603 25
CERTIFICATIONS ANp ASSURANCES FOR THE SECTION 6311 PROGRAM
This page must be wmplefed by checking the cedigwdom and assurenroa Pat apply. The
IntliNtluel auPOr~tl by Pe ApDlicanfa governing hotly le submlf the appliwtlon, make the
necessary certifwtipns. antl enter lnW agreement must sign where indlwted. Tha ApplicanCa
attorney must also sign the form. the signatures assure the NCDOT and FTA that Pe
Applicant In[¢bds Po comply with Ne regUlremenb for Pe Section 5311 progrem,
The prospecWa Appliwntwhose project(s) will to indudetl In Ne progrem of pmjeds far the
Secflon 5311 apDliwflon for North Carolina shoultl salad the aDDropdefe wNgwtlona pr
assurenros below. The prospectlve Applicant shoultl understand Pat Peyare cedifying not es
Pe applicant to FTq, but as a subrecipient provitling eaeurences io fhe NoRh Carolina
DepaNnem of Trensporbtion, the apDllwnf on Ks babel[ Pat II will meet the fetlerel
requinmante putlired in the ceMiwdons antl assurenws. ThB wrlRlwfiom antl assurances in
the Fatleal Register should be untlerctrntl in fgM M Nis relatbnship.
I. Cenifiwfions antl A95wanws Requiretl IN Eadi Appllwnt _
II. Lobbying CeN6wtlon }or Each Appllwnt Exweding 5100,000 _
III. Effects on PMata Trenawdaticn COmpanles _
IV. Public Headrg Certlflwtlon far Capital Projeda that W ill Suhslantlally
AHad a CommU0lty or Its Trareit Swiw _
V. CeN6wtlon IN Pn-AwaN and Past-Delivery ReWews Requlrctl
for Acquiadion IN Rolling Sbok _
VL Bus Testing Cergfwtlon Requiretl for New BUa AV{uisitions _
VIL ChaMr3erviw Agreement _
VIIL SMwlTrenswrtatlon Agreement
IX. CeN6wtion Requiretl lartM Awak Of FfA Assistance to Pn
AplNiwm mr lb pemantl ResponaNe Serviw _
X. SubsWnw Abuse CertMeadons _
XI. CerAfwtlon for Pe Job Aaxss antl Rev¢rsa Commute Program
XII. Cedifiwtions and ASSUrznces for [M1a NOnurbanlzetl
Area Progrem
AO RTFIC T O UIRED B NCOOT RE USE OF
VENICLES PURCHAS USING FEDERAL ANOIOR STATE G0. TF
AI'vanicles purenaaetl wHh State enNar Federal funds, indutling eNStlng vehicles
antl any vehldes purchaeetl In the future, shall only be used for the provision of
public innsportatlon xrvi~. No vehicles pu¢hasetl wiP State antllor Fetleral
Ponds shell be used by any stag member for any other puryose.
5£Y1W3 Ca®ily T~NSpedad®Mngrem
Ftlvel Secew5311 LCtiG®tiwe W gefmm[¢
AFFIRMATION OF AFPLICANT'8 gTTORNET
(Legal Name o/AppliceM)
SFY20g2.2g038ec[ion 5311 Program
As the undersigned legal counsel !orate above named Pppllbrd, I hereby affirm that d has
eu[nodly under state end Idml law b make antl comply wrtM Ne ranlflcalipns antl esaurences
s intliptetl an Me foregoing page. I fuller affum tlrat, in my opinion, the certlflcations antl
assurencea have been matle will proper legal eNhority antl CpnSLfNe IBgal all hintling
pbigetlom on fhe Appicen[. -
I mdher aRrm to Ne ADDOcentthat, fp Me best of my knovdetlge, there is no lag'slatian or
tl5ga0on pectling or imminent that might aCrenely s8an Me treliblly of Mese cedifiotia~s and
asaprenGea, or of the perfonrenm of IM1a pmjec[.
oau
Name of ApplicaM'a Attorney
~.~.a,ae~aaa ,f, ~d~~A.wa.~
CERTIFICATIONS ANO ASS a CES FO FY 20024009
Legal Name of Applicant
Name of AUthprizetl Representative: _
Relationship/Ftlle of Amhprizetl Represenbtive'
By signing betrw, I (name) On behal/ onhe
Appllcanl, declare that me Applcant has tluly aumotlzed me to make mesa certlGCelipns an0
assurances antl bind the Appllwnl's wmplienos, Thus, the Apvlirant agrees to comply wlih ell
Fetle21 statutes, regUlatlons, ekecutive ortlam antl atlminlstmtive guidance requiretl for the
Secllon 531 i appllcatlon Fhe Nodh Carolina DeparimeM of Transportation (NCDOT) makes to
the Fetlerel Tmnit gtlminlslra0on (FTA) in SFY 2002-2003 (FFy 2002).
FTA antl NCOOT intend flrel Pe wtllflFatlpns antl assurances the Appllwnf salads on Nis
form, az rtpresentatlsz pt Ne wrlifira0ons and awnencea d the Community Tansportation
Program Appliwlion, should apPty, as required, to each project /orwhich the Applicant seeks
FTA assistance through NCDOT nav, or may lateq swk FTA aeelsfenm mrpugh NCOOT
tlutlng SFy2002-2003 (FFV 2002).
The Applicant dfflm6 me truthfulness and awurary of the cedifio(lona ana assuranws tl has
made in the statemems submMetl herein whh Nle tlowment and any eNersubmissipn made to
NCDOT for inclusion In s submission b FTA, antl acknowletlges thatthe proNSions of the
Program Fmutl Civil Remedies Atl o11g96. 31 U. 5. C. 39d1 et say„ as Implementetl by
USDOT regubtlons, •Prpgmm Fraud Olvil Remedies,"49 CFR Part 31 apply tp any
certlgwtlon, assurance or submission metle to FTA.
In slgnl0g this document, I tleGare antler pemhias of perypry that The foregoing certifrations
and azsumnws, and any Nher flatemeMS metle by me on bBhatt Ofthe Applldant are true and
cometl,
A
Date:
81Anetaro of Authohzetl Represenrative of Applicant
PY 2W] CipAy4cadw
Nwwq $eMCe Agwry Trmspwatiw ReaOWtiw
Pagel
HUNAN SPH'I(S 'E T A N 10 E I T10
RE60LV3]ON
APPUcavt 6wkwq Pv®ctiw ~o ApplY fm HUmm 6emu Tn..... Fupdmy,
Pvtet Ivb AgeemeN wny rye Narth Lvvtin. -~aswat Of Tsampmpuw
Mdm hvvNe Phe Napery ASSimpceq,
A uwtiov µv aadc by (HaaN MmbrY Nmne)
mdaemWetlby (BOOMMmxbxiNUme)
[m Ne adoption of~hetagowivgneolvtiry mtlvpvnbemgpulm aws wm dvtyadop J.
R'Fffy.EAS, Attlcle2-o((hspm 136 oflhe NwNCaml'm Gevvy 66Nbe avd6e Oavemos
of xmq Cw~e My deYgyaxd We NaMtasnboa IXpugle0 a(Pmwpatitlw QJWOTJ m
ibe agwcY serymuble Im ed®nimsivp IMvd vtl sire Public I mnepmutien (w~i eM
wlSRpw6, 0u NOedl CUO4ve DepmmntoP'Reonpos®tiw wefimds 6ompe NOM
CamWU Omeml geeemblympmvih am'iRmeef wal PUbYeuwppeitiwpeojeei; and
MRfR5A6~ 0e pmyae ofMUetenlawtiop yndsu bgovitlegm[mvnieA Iv Iwalegepvi¢o
fm the WOruiao of lmelyOGO VSUepwmewvemcee:
WF~P.PA4(d--llm~Ya Nmne) heaby
ume ®d cwtifies PoN h Wlwvgly wiM Yle (edadavd slate 6nm¢e, regalsyovs, executlere
mden, and m ea~maiatie.egmemwimimtl m dw applieetiwenvde ro emgrmmmpi.red
~ ~. xwm cm>b. -ep.~nn®l of n®ep~emn;
xow, THHxspoHH, m rt eewved m.t rk wnunswd ogr<•.aI ~~ r~*1.1,
m(xn...tnvi:.o.t'. G~.n,mganay)
m nmhr anllwie.aro mb®tagnvt wp4wtiw Meese rwawg, ®ke tlwneceeevY urewences
ana c.mr snow wa e. ampawam m®tp mw en.®.®,eae.tm the NCnormp;nride enrol
public amxpvmuvv eavicec.
IICatlJM806'mlY Name)'.. - (TFe
tlo Mehy eauy rhaz qe above u v vue evd ooveG bopy of en exeeryt 6om 5e mautm of n meepug of
auly heldw We_NyM 10
ngnnn.r. f~nln"ng Opiciol
Nome lived Governing BenN
.4Y4mt®eW~ ~~~yo~R a~~ (;mNAPPbutlm
~,~,
Fm APPUm4m rhea ss~Nl w•ereeb
veymd9mvPU~hagogam.
the N-owWg h^€xGa eEe3 bovude Part afWe mrtiec[ ofaa.ieuvice myh We Smre m ot6m
pabtlc 60% Wmgtl web aPOta[im mW +1®INttion of favtla pmWhd vadu Na
GrmrvmtY~tOPOrtYiw Pro Nam (CPP):
A. Gepptal ApplioYOp
'ITe Pubic Be% (lye NaN Gm~a Oepmmen[ o('fRmrprtaNpj egyg ~ N (Ixi
iyaerco of wvvx % We U. S. DePanmem of Labor, tlm tam ®d toditbm of tMs
°'mramY. u e& ImW eaaaw, obey BpPjY fm tM Mtectiw of the vxspgNtlon relntrA
empbyaa ofmry m¢1oW MOVidmB m^+POrtetivu xrvkes azusted by the
Pmly t. ...m...,..
APPGmm/RVapm q eea wa narmpom~tlm rju.dw o tpa of am ot~hm wfce we
aampartamcP was o,ee. h:napo oeuu.ire tlBPpmjaL W
'mle Went soar W.u prcwe m em u. s. o<pana~ of IabPr em maavn at W ivy
otunb the Pm}a ®xnvNe, op.[o.aale 4y(IDg of ep eygppq ypgportazloa P~e~adea whiey
eE&Fja Ax'ipieaze o[nwpe[uNm asdnopy rynaed 6Y <ha P/ojx4 a the vauPOtelnv
aemce arev of the Rolm.. ®a soy hhvr otgm'Parby repnmePlpq the avRlvyers of auN
pmvWen.
a tihcmav by We'PVbliv HvdY w the U. S DepsnmW of Labor rhx ih deiguNW
®RW~e have iWiapvy m wt¢mg auYp~ta of ih teepe mL ppapvm vP ~ wmavry
Smmm wiphe e~jt{y[ b pmv¢ the8or vfClp fardm9lp µe ayyece of a fiotlmg of
rnirvuPbeacby tMOepvgma oPLeMr.
H. SWVdvrd tEmr svd Cmditlvm
tO the Project emu tie ;arid cut m aam a ranee ma uPOn wm tam sd mvmuou ea
wa w~ o^',maary urea ®pmwua of me xecp~cor ®a ar wr ewc aa~faw eabk
vwponatiov pmvitler m the amnPanabv mvlz mm M rN Pmfars. It Wall Ix sa
o6E6 b v of aye Het4nm and vny albs legs%eevpw.a3ds Pant detl@laNd by ~ Peb&
For mtl opaaEl hl Guth a mam4r Na[OaaEOa ervims a96Yletl by IbB P+0.at ue a0vtrurd
mvpbymv'fie ~nm'Rrojx[°. u uce~ av vd hvMh ~ aNha am ma0B6 daaccietl
tuvie, or opmxion "°a.•d Peams~ °~ m[ ba>®W tv td peamulm ptilyy.
by fimd5 hm eha0 mcbde ®Y chmgq ataFs
36
~Ymm fn®®tl'a~+he~Pn9®~c~am Awlhtlm
Pye1m'S
vraevverimµ epsaziovy weboologrcel, or othgMeq which aR a PvvR oe Ne wiBlm¢
pvWded. The pNUa "a a rmuR e(We IMjrt", ahh wfEe metl m This vrrm6®r+v. seNae
eawu selewtl w the Pmjxl oawriop m mtlopetiou oT', tlebg, and mhvrquwt m Ile Prov4a
am em'Pwgvw of e1£auecbe or ewnoMa reYW throe: pmNaeQ 6owava, Nm mn,..e
vee arW fel~g aeboimeu. vraf~gea m phme ®d Chy Tm ofemPbY~t bmuHm ebavt by
nova oma tbm the Probe Qr¢Ndmg mY ~eolmm ar IDcimclalmwhvA w 0e Avjxl)
arc eot wiWm ttr puevivw of INS armgemca,
M evgbym <ova.d by dds artmgerem[, who u m[ d®aaexl, aieylxed ar vNUwise
emd w 6b pasmve wi[h regxtl m hh mwmymam a a rnWt o[ td ProjM 6vt who u
awrmsaa, aivpleaa or vrhmwfse wolwl~ mhrybaaus aP the lotalorparcelsawmedm of
de Pwjmt dheommumce of PrO)sl mvix%. or exheutiov of Rvjat (endive shop ml be
dsmetl etig3m for •diemhsater diRbre®m vlloweocewuNv the nee~g of pemgeplu (6)
ma rn oe me. New n~mml m apphaNa pwWagm of mnemne mrmmaee
e1lBUhaEPYla
(3)(a) µ'hfR e¢pmya.. of a Nmlpluu ore repea~ad mr nouxu.e hwgtlvlvg purpox4 e0
Pwjm satrnpwvia i bytht emRxm shall by PwWtlW vmtr mE iv ucmasvmwith my
[vllsti~x Mrgmmq p®pep®t app4nyb to tvehpmplo3eq wNChi3 VBe meHev'[.
031LeRafpiwrt mbgaltyrespoevbb PanyabellpmWde w aLLeHaxd empmyea ~tl (sh3
Gaya vvlice of mlevtl i 9pliovl wh¢ti mry t¢y$ b displmemeex m dh~sae4 w
remrengelrena of the welkbg (easy, fe Iba wC e(emple)m IepleAaaa by am1o41uch
Iim shell be pwWwA by velti5d maa dwvgp rhv rtpresnwawa ltv vvace shall comLn
fl mu and ade)uale gyavml v( epe ploposaf e6elgq ava m rst®h oI tM vYmM of
emPmYUS atim'mA by tle m¢Med NVrjef. and ther~Lx mtl 4usEleptioes of aeYloM v
the Rwyuvt's empbynxot avaleblsm beNM by suchaSVVef empley,Ya
(c) Tm procNUra of daa mbpewgwph ~ eppHxo roles whew vo[W mvolw evgbyxs
npreventetl by a mtiov w[ ov1MIM Glgaabg pwpoq. M Na regpal of a4w Iba
seaipbm w me rePm'am.time ormm aepmy~v. ve¢ouclbw Por dx p„rpoaa of rexhme
agvvmA witL Iapel w Iha appliatiov of We Iemu aetl mvtlNOec of leis artmgavest:1x11
i 1iaWy. If m egreevm[ h rncped wdhm twmry (20) dvYa ham ~
ovvrcacweel of vegvveame, avy party [o Yve Clepu¢ maY syheW the ®tle' w diepu '
eertle®vt Pwcmutea a axW""» wiN puagaph (a) of We weemly. the mregr,'xg
prardveu ebep be a.~prd with ma mrea em prior w fh uumpov of tEC Nrcvtlod
xtiov
(3) Fm the PxPVK oe proxaine tlre..,^,mry regvbef promcliwu ivcWamg rhox S~caeY
rNVtlWtl by Seetlov 5333(6) of We Ael,' Its puWs 0ody wJ1 uwre u a mnEilioe 0f W
relax of Nnda tha[ We Rzgmm agm ro be bond by the Ivw and wvdubvs of ehs
Netiovel (ndotlvp Sectiov 5333(6) Agle®eot mexuva Iuty 23. 19'/3, itlevlified below,..
ryoWdm rhx olhcmropva6E artavgevmv v>Br6e mhtimwa IhmCare, xmmo.W M ma
3eC(amyof[xWr mdnerlNetl Wr mclueiavmWasa <omavru.
eermna~~.na'>v.°a°.mmanw®(aYe)c..mnwumuw
sprevi s¢omswR)wemy
Pep36S
(a) nro auPUre m.ammvmr ariabg r.gamloe we aPPSmmw raapexdea m ®mm seen
afmYafNepromdom of[hie ¢rmgeroom whbh r®°~ be em~ad yy mtl betwcathe
¢ imxess wvhm mvq (307 d=n ass the a~mm armme.¢y~ aer ¢*as. may be r rrm
M mY vwb P°eY w mY fend mtl bmdmg diepuM ae¢b~ot pee¢bm apYp[ahL w [he
,om~ Va event shay caWO[ ages Woo mcti Pm~dore, m [he u. s. uryvnraw of
mpaeuN 0hd piny aesig°.rm by ~ u. 3. +laalwruoeot o[ Ishm for Caml and
EmN°g 14e~mmuiom 1"m a°mpmuei°a sad mpmwa °f rbe om¢tul VorG R Y. 9vd anY
ath¢iobely xemea aapenren. vh.nm hmm wa+hr by ~ pmtiea m am p°°e~ em m
oN¢upmua ehePbePaN bytpePmY bcu¢iW tlma
Iv the sums of mY d4pub az to wheWm ¢ m[ a gmua¢ mopbyea wu fixed by toe
Proiex, a aFW be hu obtivpti°e m iJnuly rbe Rolex mtl aP°ufY the pmamt 4pe ~ t6e
P+Went regea Won b shell then he the but@a oFeiWerdm k[rip4m er oN¢ party legahy
raaPOdalhr for lne aPPbretba ee .nee waaui°m w pevn thu eamre oW¢ wev ar Proiret
-afiersed the avgNYeea. Tne [Winne xvPbyee Ytll Prenaifa u esmbeahed tM Om RoJzt
M1+e.m e8m upvv NO etvPbYee ovev 6°thv9¢nrv may elw hiwafle:¢tltle empby[t
(3)'R° &v.'lplwt °r inner legepY re+p°°¢bN P¢ty tleelgpged by the Pudic Hoax wN he
6omcalty teep°mrole for We appticatiov v[ de¢ mMAOm ma win ma6s the rcmaery
oetrmpemmta n sent soY empbyee covered by these enmge~tq or Ne uvbompreammare
mQwyre may de clams ofvbl&m °f shine maWevtmm w'uh tbe Reclpam wehly
sL:ty (m) tlan of wa tlaN he u uae®mma m Ivd °H ¢ e rasoh oP We R°J¢a. m whhiv
mgdeen ([8) mmpe of the d¢e Ina poabv wN rtaPect m ELL ®Pbyrmm h oWenuisa
worsmea u a rcavR of rh R° jxa b dm Yna aae,d om eaW a ®vbg rbe m the el®m have
acau¢ea ov¢ m ext®dea pemtl, Ne oghtse I18J moms I®hama cbee 4 ¢euurea 6om
the Wt evc6weN. N° heWy m.uwwywe Nr avyperloa ryi°rto art (6) movtFS bom Ne
Gets °ftMAbBNmYCWm
(61 N°rdng m thu+^aaepmm ab°Y he cauvueG m 6.privmy sq eepb)ae stay. MAlc er
bmefiu which mcq empbyu my haw vvtle[ Gtiel¢g employment or mlk~re bergammy
=UVemzxa mr snap tlw mrevg~mt heammed a wely¢ ofagsigh¢ ofmy u~3o or °Paay
reprasmmd ampbym dethrtl hominy owe epeamtmt m povitl°e offedmel e¢te ar bol
bw.
()).ln Wa even oy Sys aoraetl by thrse maagmesse u tm~®uai m 4itl o8 as a
roan ofth° Pmle°S he shell he btmm prbrny of mgbym¢c m remWkYmmt to fin say
vmam Pvation WGm the coevol of the He<lpim[ for which he u, m A ¢+b+v6 m retrebaog
vd° a reisombb P¢iod m btm~ gee8fiei.In d¢ evml ¢al^be or emmbe h sW°uvn
by v+ch ®PbYmmt or ra9PbyWm, she P.w~ia[ er e[hE kHaPY euPOaeble piny
m 1¢radetl bf she Prbpe Body shop pmviae or povide for wch ¢ddeg or reoammg ¢ m
ten am evmlyz
(87 the Raipbot wdl poR m a Pm~ev[ and acceesble pb¢, a entice eutmgth¢ the
36
8W N63Cm®bIIeetPmYtlmM^9~s R~IP1 WaR A4pk®tl®
9rytlY8emlmp3lDtl WVrmry
Pµe<K]
P.mipient Eu rereimf YNeN pketeow wdp rlu [bdmd itmk A¢ and bu aP]md w
coPgyv wkn Na pw.;aoPa of seeim 339aro) of Le Arz tb;a Potka ab.u atao aPeairr rye
Lmroa wa emdlLkm ae mrrh knob ma Lbe pwrectkn of emday~ ne. He.;Pkat ahm
yam ma ~-w w me .u rewm boor, am rmea m aui&km dereu e m prove Ne
bask womunaaaemeey tewo PraP=wpgcaakv, atla~d+etkq am mmrcervmr ofrnpe
etrtvgePYOp arA rd dm proem d<t~atkn of am aAka adnsmg reer.md:r.
(9) Any Hbor o~.don wEmp b dw vocative hnyvl~g ICPRAwLaLive o[ eroPkym
mwretl by ehrw artavYavevas, meY bmpae a Pvdy tp Nme amnyoLame hY mvbg wTkrea
mti'z va deede ra m m vpoP Lhe Heclplmr am the V. 9. kPetmam of Lbm. Iv the eurew
of wytlYagNpmmY WrtaurA bhar oegyL¢sLvm reP[emis wVGal empbyCl, orAa MMrwiee
wgLb a yews a eery io Lheae a^m4emmn, u giptim Le ehe Pw}i5 Os tliapure u e
baba swh orgav(atlioa eheP pert'v peLe shall to duav®ea by we gwd.y o[Iabor.
(1011e LbeeYm[ Lk Pwjep u eppawtl lm eaahrav¢ vntla tlu M, the mregdag army and
cootlitkvt ehekbe ~ Part ofLe rordreCl oyudaLmabeLwem W mtlordgovemennt vvd
tbe Public BotlY or RGPku of Meal Nods: pravbM, 6vwesa, the[ Lis enmge~nt aMp
ae merge arto the aoatract N'eeeistuce. hm elullbe ktlepeodmtiy bivdQq avtl wmrs+bk by
mdapov Gzpnles tUerelo. avd by mYwvmM mpWya m hu repwereetlvz, m esadeoce
w¢h RS rer~,POr ahaP evy oJm m¢lo}ee Protmivo epeemmt vrerge kw Wsarrc3geumt.
wt each smu x ma=emdmtry bbdeg wtl mmq..ble by ma aPw Ne mrdea mppo, m
ssmrtlavae wilhva mrmc
C Waiver
As a part of ~Ee y t approval Prows. ehb:r Ne Rcppiv m oNtt kgeN'resPoptiye Lvr{y
dea~aLOi by Ne Pob4c Hody vuy w wramg talc fiom LFS 9nxu y y ]plpr a wuvv of the
auntary rcqutred yLOtctims TM Smeary wN'wtive then proreaiovav wva where a[
tho Lvm o(We rcgyved Wtisa, We 9sreurydea®ov rhaz Nert x vo ampbYees of We
PmWSTr or of evY aLx smi puNk psnsputiw provtlpamNe Rdprporhtion euvse
ores who wuW b PotmtuVy efixred by LLe Proy¢ A rNtty (30) tlq mLiz of proPOStl
i~vswiPbe giam by Le [1. 9. C¢penmm oPlebm avd N tlu ahsevice a(umely objxeloq
tbe wavm wN bxorm taut o[ the mtl oP de thutY (30) day votke petkd m Ne asvd of
[umAy objmdoq Ne [t. 9.4pwsnt of ]abor wID revkw WC dBLmraW dsemLc whcNc
a weiv& shall be pemol. Ov hyv absaom of wYUV, typo pscucruve shall apply w t~
ROpt
Naas
• 9whproteEw aeangeokob Lab be'ydq wjlhout beag limaal to wch gvvuiarsssmY
bC aCCC&LNY mr (p Ibe Pf{ytM1, q(10110f Ifgd0. Pvsk~q 6Yd bmefd9 leaNdBlj Caa1~18da0
of pensuv rigMe am bmefiu).mdp mtlvuvg mgmtirc bazaammg eg¢Lhms or otheWnse:
SFV iaeE t~uW9in^gwm4w Prog.m (<'t*1Gnx Metiatlw
9nuJeuXm SDJN)wxury
Agsms
(3) ik coauaaaziov vfm6ctlva 6ugamiv6 ri~rtel (3) lbe pamcpoo o[ mtltNUai mgb3~
agabat a wmee~g of Hu'u poeaovs wiN respm m Ru'v m^PbY®: (4) mvuarcu of
empbyv~r to emple5®a of mqu'vd mess amupoMUbe 'W~ .m pr;omv a
esvNmymene of empbyeu mrmmatd m IeW vfi; ad (5) pytl o-a®g eptl roo-e®g
~gvrvc Such aeeapgua®u eAa6lncpWe FevviBinm moraYbg mtivitlu®¢~ioH aGWaz
eev®g of Wevpot0om wIN reepvct to Wetr ~PloYmval WicpetuY¢ vo erxatpmvule
teuefiu leas mm Woc cembpebctl Pmmam m Sratiw 3RH~ of W Avt afl'ebmmy 4.168]
(2l SILL 3l9), u emevyy.
•• For OlWvaea of Wie wenm[Y mmnea~e. puagapha Il): (a7; ~; (l5), faz); R31: (K):
(2g); (2'n; (281: entl (29J of Vu lfotlul Sxtiw 5333(6) Agmmml, mcmd July 23, l W5
verobe o®¢ed.
O. Ameplavre Mgpasul3evtlva 5]33(p)Wmndy
1. (NUrcad'iLleJ StwpMn galklotig, flair
tla hmebycgti(y
Ow (Ie6vl Name of App&mVBetip4yq Daa ye Cnisky PayG o(Ganpyeei¢Y[a
6ae aged b'Fe rqm antl mndltlone of tlm Wvnery eM will ssspr rhlp cgrtyrevt u psn
of mecovtrazt of eep[{avicewiW W Nort60001'ga Dgie~va of Tmgprrtgjoe.
Due
3pg1
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