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<br />DENR CONTRACT NO.P06038 <br />DUNS Number:809785280 <br />CFDA No:15.916 <br /> <br />IN WITNESS WHEREOF, the State and the Applicant have executed this Agreement in <br />duplicate originals, one of which is retained by each of the parties, as of the date and year first <br />above written. <br /> <br />Applicant <br /> <br />By <br /> <br />Title <br /> <br />STATE OF <br /> <br />COUNTY OF <br /> <br />On this day of , 20--.:..." personally appeared before me <br />the said named , to me known anq known to me to be the <br />person desctibed in and who executed the foregoing instrument, and he (or she) acknowledged that. <br />he (or she) executed the same and being duly sworn by me, made oath thatthe statements in the <br />foregoing instrument are true. <br /> <br />My commission expires <br /> <br />,20 <br /> <br />(Signature of Notary Public) <br /> <br />NORTH CAROLINA DEPARTMENT OF <br />ENVIRONMENT AND NATURAL RESOURCES <br /> <br />Director/Division of <br />Putchase & SeNices <br /> <br />WITNESS: <br /> <br />By <br />William G. Ross, Jr., Secretary <br /> <br />Signature <br /> <br />ORIGINAL <br /> <br />F""-4- <br /> <br />Page 13 of 14 <br />