HomeMy WebLinkAboutINRCOG - COVID-19 Relief - Part F Certification - 5.17.2021 COVID - 19 Relief Recreational Trails Program — Certification
PART F- CERTIFICATION
Before certifying the accuracy of this application, please review the program guidance and all required documentation
and narrative information below. Ensure all required submittals have been completed prior to emailing your submission
to scott.flagg@iowadot.us by May 17,2021,by 5:00 p.m. CST.
Required Documentation and Narrative Information
Z 1. An APPLICATION FORM(Word format)with all parts completed.
® 2. This CERTIFICATION (scanned PDF format) signed by an official authorized to represent the applying
organization.
® 3. A DETAILED MAP identifying the location of the project.
® 4. A SKETCH PLAN of the project, including cross section for bicycle or pedestrian facilities.
® 5. DIGITAL PHOTOGRAPHS (limited to five) that will help to explain the existing site conditions of the
proposed trail.
® 6. AN ITEMIZED BREAKDOWN OF TOTAL PROJECT COSTS that shows the method by which the cost estimate
was prepared and enable a reviewer to determine if the cost estimate is reasonable.
® 7. AN OFFICIAL ENDORSEMENT(RESOLUTION) of the project from the authority to be responsible for the
project's maintenance and operation. For cities,counties,or other political subdivisions,this should be in
the form of a fully executed resolution by the elected body or board,as applicable.
❑ 8. AN IOWA DOT DISTRICT OFFICE LETTER OF SUPPORT if the project will include construction within Iowa
DOT right-of-way.
® 9. MINORITY IMPACT STATEMENT
The undersigned is an official authorized to represent the applying organization. The person signing this document must
have the authority to contractually bind the organization or be the designated fiscal agent.
Certification
I certify that all proposed activities will be carried out;that all grant money received will be utilized solely for the
purposes for which it is intended;that records documenting the planning process and implementation will be
maintained and submitted when requested,and the Iowa Department of Transportation is hereby granted access to
inspect project sites and/or records.
To the best of my knowledge and belief, all information included in this application is true and accurate, including the
commitment of all physical and financial resources.This application has been duly authorized by the applying
organization. I understand that intentionally providing false information in this application may result in criminal
prosecution under Iowa Code§ 714.8(3).
If funding assistance is approved for the project described in this application, I understand that an executed agreement
between the applicant and the Iowa DOT is required before the project can be started, costs incurred, or such funding
assistance authorize with the Federal Highway Administration (FHWA)for use in implementing the project.
I certify under penalty of perjury and pursuant to the laws of the state of Iowa that the preceding is true and correct.
Printed Name Quentin Hart Title Mayor,City of Watrerloo
Signature ��o M Date /�-7 / 1� Z-