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MnDOT Agreement No. 78569 <br /> <br />1. STATE ENCUMBRANCE VERIFICATION <br /> Individual cert~es that funds have been encumbered as <br /> required by Minn. Stat. §§ 16A. 15 and 16C.05. <br /> <br />Signed: <br /> <br />Date: <br /> <br />CFMS Contract No. A- <br /> <br />2. GRANTEE <br /> <br />Grantee certifies that the appropriate person(s) <br />have executed the contract on behalf of the Grantee <br />required by applicable articles, bylaws, resolutions, or ordinances. <br /> <br />By: <br /> <br />Title: Chair, NCDA <br />Date: <br /> <br />3. DEPARTMENT of TRANSPORTATION <br />By: <br /> <br /> (with delegated authority) <br />Title: Director, Office of Transit <br /> <br />Date: <br /> <br />4: <br /> <br />Title: Vice-chair, NCDA <br /> <br />Date: <br /> <br />Recipient's Signature Acknowledgment <br /> <br />This instrument was acknowledged before me this __ <br /> <br />day of <br /> <br />20 _, by <br /> <br />the <br /> <br />(title) <br /> <br />and <br /> <br />(name) <br /> <br />the <br /> <br />(title) <br /> <br />of <br /> <br />(recipient) <br /> <br /> NOTARY PUBLIC <br />My Commission Expires: <br /> <br />Word - Amendment form Rev. (5/00) Page 3 of 3 <br /> <br /> <br />