AgdaPkt 2006-11-13 - Laserfiche WebLink

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STATE OF CALIFORNIA emMB 669 (2104) 6.20 CALIFORNIA INTEGRATED WASTE MANAGEMPa~~"1Ol GENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS Comments/Notes; Mark (.I or X) appropriate box below. PRIVATE ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the State of California that the proposed grantee: 1) is in good standing and qualified to do business in the State; o and 2) has or will comply with all applicable state, federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 3) where compliance has not been met, I have attached a letter describing what has been done to achieve full compliance. PUBLIC ENTITY CERTIFICATION: I declare under penalty ofpetjury under the laws of the State of California that the proposed grantee: I) has or will comply with all applicable state, federal, and local laws, X ordinances, regulations, license and pennit requirements necessary for the proper perfonnance of this grant; and 2) where compliance has not been met, have attached a letter describing what has been done to achieve full compliance. Executed at: Redwood City, CA City and State on October 31, 2006 Date Larry Barwacz Public Works Services Director Print Name of Grant Applicant/Grantee (as identified in resolution) Title October 31, 2006 Signature of Grant Applicant/Grantee (as identified in resolution) Date Note: Falsification under penalty of perjury may result in criminal and civil penalties. In addition, pursuant to the terms of the grant agreement, any misrepresentations in the above certification shall constitute a breach of contract that could result in non- payment of grant fUnds to the grantee; relinquishment by the grantee of funds previously paid; termination of the grant; and/or placing the grantee on the Board's Unreliable Contractors List. Tlre-Oerived Product (TOP) Grant Program, FY 2006-2007 8