2016-092 Resolution - Laserfiche WebLink

Home Browse Search

6.0 Attachments / Completeness review Confirm in the boxes below that each item listed is attached (Check each box) A certified copy of the legislation by the governing body of the applicant authorizing a designated official to sign and submit this application and execute contracts, This individual should sign under 7.0, Applicant Certification, below. A certification signed by the applicant's chief financial officer stating the amount of all local share funds required for the project will be available on or before the dates listed in the Project Schedule section. If the application involves a request for loan (RLP or SCIP), a certification signed by the CFO which identifies a specific revenue source for repaying the loan also must be attached. Both certifications can be accomplished in the same letter, A registered professional engineer's detailed cost estimate and useful life statement, as required in 164-1-13, 164-1-14, and 164-1-16 of the Ohio Administrative Code, Estimates shall contain an engineer's seal or stamp and signature. A cooperative agreement (if the project involves more than one subdivision or district) which identifies Elthe fiscal and administrative responsibilities of each participant. Farmland Preservation Review - The Governor's Executive Order 98-IIV, "Ohio Farmland Protection ElPolicy" requires the Commission to establish guidelines on how it will take protection of productive agricultural and grazing land into account in its funding decision making process. Please include a Farm Land Preservation statement for projects that have an impact on farmland. 0 Capital Improvements Report. CIR Required by O,R.C. Chapter 164.06 on standard form, Supporting Documentation: Materials such as additional project description, photographs, economic ❑ impact (temporary and/or full time jobs likely to be created as a result of the project), accident reports, impact on school zones, and other information to assist your district committee in ranking your project, Be sure to include supplements which may be required by your local District Public Works Integrating Committee. 7.0 Applicant Certification The undersigned certifies: (1) he/she is legally authorized to request and accept financial assistance from the Ohio Public Works Commission as identified in the attached legislation; (2) to the best of his/her knowledge and belief, all representations that are part of this application are true and correct; (3) all official documents and commitments of the applicant that are part of this application have been duly authorized by the governing body of the applicant; and, (4) should the requested financial assistance be provided, that in the execution of this project, the applicant will comply with all assurances required by Ohio Law, including those involving Buy Ohio and prevailing wages. Applicant certifies that physical construction on the project as defined in the application has NOT begun, and will not begin until a Project Agreement for this project has been executed with the Ohio Public Works commission. Action to the contrary will result in termination of the agreement and withdrawal of Ohio Public Works commission funding from the project. Certifying Representative (Printed form, Type or Print Name and Title) Original Signature / Date Signed Page 6 of 6 Form OPWC0001 Rev. 8.11