286-25 FY24_Exhibits.pdf

D-1 EXHIBIT D FORM FOR SUBSEQUENT OBLIGATION OF FUNDS The USDOT and [recipient name] entered a grant agreement for the [project name] that was executed by the USDOT on [date of USDOT signature on original agreement] (the “Agreement”). This instrument obligates [$XXX] for [insert portion of project listed in the Agreement]. [Recipient name] states that: (1) the Agreement accurately describe the Project’s activities; (2) for each completion date listed in the Agreement, the Recipient’s estimate for that milestone is not more than six months after the date listed in the Agreement; (3) comparing the Project’s current budget with the amounts listed in the Agreement, the “Non-Federal Funds” amount has not decreased and the total eligible project costs amount has not decreased; and (4) under the terms of article 21 of the General Terms and Conditions, the Recipient is not presently required to request a modification to the Agreement. [Recipient name] acknowledges that USDOT is acting in reliance on the Recipient’s statements above. Date By: Signature of Recipient’s Authorized Representative [insert name] Name [insert title] Title