Laserfiche WebLink
DOE F <br />(o~-g4 ) OMB Conm3~ ~ <br />All OZher Editions Am Obsolete 1910.~ <br /> <br />The applicant agrees to submit requested data to the Department of Energy regarding programs and activities developed by the <br />Applicant from the use of Federal assistance funds extended by the Department of Energy. Facilities of the Applicant (including the <br />physical plants, buildings, or other structures) and all records, books, accounts, and other sources of information pertinent to the <br />Appticent's c~mpliance with the civil dghts laws shall be made available for inspection dudng normal business hours of request of an <br />officer or employee of the Department of Energy specifically authorized to make such inspections. Instructions in this regard will be <br />provided by the Director, Office of Civil Rights, U.S. Department of Energy. <br /> <br />This assurance is given in consideration of and for the purpose of obtaining any and ali Federal grants, loans, contracts (excluding <br />procurement contracts), property, discounts or other Federal assistance extended after the date hereof, to the Applicants by the <br />Department of Energy, including installment payments on account after such data of application for Federal assistance which are <br />representations and agreements made in this assurance, and that the United States shall have the dght to seek judicial enforcement c' <br />this assurance. This assurance is binding on the Applicant, the successors, transferees, and assignees, as well as the person(s) <br />whose signatures appear below and who are authorized to sign this assurance on behalf of the Applicant. <br /> <br />Applicant Certification <br /> <br />The Applicant certifies that it has complied, or that, within g0 days of the date of the grant, it will comply with all applicable requiremem.~ <br />of 10 C.F.R. § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE). <br /> <br />De~ignate. d Resp~on/s~re, Employe. e <br /> <br />Naae and Title Prtn~d or Typed <br /> <br /> (704) <br />Telephone Number <br /> <br />Cabarrus Dept, of Aging <br /> <br /> (7041 <br /> <br />Applicant's Name <br /> <br />Telephone Number <br /> <br /> P. O. Box 707 <br />Concord , North Carolina 28026 <br /> <br />Address <br /> <br />Date <br /> <br />Authorized Official: <br />President, Chief Executive Officer <br />or Authorized Designee <br /> <br />Mike Nurph,y - Director <br />Name and Title (Pdnted or Typed) <br /> <br />Telephone Number <br /> <br />Signature <br /> <br />Date <br /> <br /> <br />