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As the duly authorized representative of the applicant, I hereby certify that the applicant <br />will comply with the above certifications. <br />GRANTEE ORGANIZATION NAME: <br />A IL PP &TM WOW� A%4 DS <br />PRINTED NAME f? AND TITLE OF AUTHORIZED REPRESENTATIVE: <br />m J DW c com v <br />SIGNATURE: DATE: <br />12 -i- 3 <br />CONTRACT NUMBER; <br />J <br />NCDA &CS Certifications & Assurances — State 1112 Rev 7112, 9112, 10112 age o <br />F -7 Page 248 <br />