119-24 Attachment - Community Energy Plan Grant Application.pdf

Community Energy Plan Grant Program Application Packet Program Year 3 Page 10 Applicant Certification The undersigned warrants, certifies, and represents that: I, (Name)_______________________________________ am the (Municipal Position) _______________ of the Applicant, (Name of Municipality) __________________________ , and have been duly authorized to file this Applicant Certification on behalf of my municipality; and I hereby warrant and certify that the information provided in this application package has been personally examined by me, is true, accurate, complete, and correct to the best of my knowledge based on information personally known to me or upon reasonable inquiry of individuals with such knowledge; and I, on behalf of the municipality named herein, acknowledge that certain information in this application is subject to disclosure under the Open Public Records Act (OPRA), N.J.S.A. 47:1A-1 et seq., and that confidential sensitive and trade secret information should be submitted in accordance with the confidentiality procedures set forth in N.J.A.C. 14:1-12.3; and I, on behalf of the municipality named herein, acknowledge that submission of false information may be grounds for denial of this application, and if any of the foregoing statements are willfully false, am subject to punishment to the full extent of the law, including the possibility of fine and imprisonment. Signature: _______________________________ Date: ___________________ Print Name: ______________________________ Title: ___________________________________ Municipality: ____________________________ County of: _______________________________, State of New Jersey State of New Jersey ) County of :_______________________________ ) ss. City of:__________________________________ ) This Applicant Certification was sworn to and subscribed before me on this ________ day of _________________, 20___ [SEAL] _______________________________________ Notary Signature [STAMP]