RFP 22-04-01 CITYWIDE FIBER NETWORK DEPLOYMENT

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with the Recipient. As part of his/her duties, the Program Manager for the Division will monitor and document Recipient performance. c. The Division's Program Manager for this Agreement is: Erin White Division of Emergency Management 2555 Shumard Oak Boulevard Tallahassee, Florida 32399-2100 Telephone: 850-815-4458 Email: Erin.White@em.myflorida.com d. The name and address of the representative responsible for the administration of this Agreement is: Melissa Shirah Division of Emergency Management 2555 Shumard Oak Boulevard Tallahassee, Florida 32399-2100 Telephone: 850-815-4455 Email: Melissa.Shirah@em.myflorida.com e. The contact information of the representative of the Recipient is: Authorized Representative: clktt-:5 CertiJ • 9u-,C4C Title: ( r(f1r S, Address: I RO 0 ` v Telephone::2 -- Email: era S.50 6ilbrX, 7) PAYMENT a. In order to obtain funding under this Agreement, the Recipient must file with the Division Program Manager information and documentation, including but not limited to the following: i. Local government name, Entity's Taxpayer Identification Number, DUNS number, and address; ii. Authorized representative name, title, and email; iii. Contact person name, title, phone, and email; iv. Financial institution information (e.g., routing and account number, financial institution name and contact information); v. Total NEU budget (defined as the annual total operating budget, including general fund and other funds, in effect as of January 27, 2020) or top -line expenditure total (in exceptional cases in which the NEU does not adopt a formal budget); vi. Signed Assurances of Compliance with Title VI of the Civil Rights Act of 1964. (Attachment D); and vii. Signed Award Terms and Conditions Agreement (Attachment E). b. Payment requests must include a certification, signed by an official who is authorized to legally bind the Recipient, which reads as follows: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812). 4