Certification of Authority

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0127. The time required to complete this information collection is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

CERTIFICATION OF AUTHORITY

The Town of _______ (Recipient) hereby certifies that the person(s) whose signature(s) appear below, are authorized to requisition funds from the Rural Utilities Service for purposes authorized under the Community-Oriented Connectivity Broadband financial assistance in accordance with the Grant Agreement(s).

________________________________________________________________________________

Title Name (print or type) Signature

________________________________________________________________________________

Title Name (print or type) Signature

________________________________________________________________________________________________

Title Name (print or type) Signature

Bonding:

1. As Recipient of the financial assistance, I certify that we are:

a Unit of Government________________ Not a Unit of Government __________________

2. As a non-governmental unit, the Recipient further certifies that Fidelity bond coverage in the amount of fifteen percent (15%) of the financial assistance is currently in effect for those person(s) authorized above. The Recipient covenants that the bond coverage will remain in effect until disbursement of the financial assistance is completed. (Fidelity bond coverage is not required if the Recipient is a unit of government or the amount of financial assistance is less than $100,000.00).

This certification will remain in force until such time as the financial assistance is fully disbursed or until rescinded by the Recipient and approved by the Rural Utilities Service.

Town of ____________

By:

_________________________________

Name (Print or type)

_________________________________

Title (print or type)

_________________________________

Date