Incumbency Certificate Form – Fill Out and Use This PDF

CONTRACT AFFIDAVIT

A. AUTHORIZED REPRESENTATIVE: I HEREBY AFFIRM THAT I am the

______________________________(title) and the duly authorized representative of

________________________________________ (name of recipient) and that I possess the legal

authority to make this Affidavit on behalf of myself and the business for which I am acting.

B.CERTIFICATION OF CORPORATION REGISTRATION AND TAX PAYMENT: I FURTHER AFFIRM THAT:

(1)The business named above is a [corporation] [_________________] formed in [________________ Maryland] [(other state: __________________)] and registered in accordance with the Corporations and Associations Article, Annotated Code of Maryland, and that it is in good standing and has filed all of its annual reports, together with filing fees, with the Maryland State Department of Assessments and Taxation, and that the name and address of its resident agent filed with the State Department of Assessments and Taxation is:

Name: ________________________________________________________________

(if not a corporation, state so)

Address: _______________________________________________________________

(2)Except as validly contested, the business has paid, or has arranged for payment of, all taxes due all government entities including the State of Maryland and has filed all required returns and reports with the Comptroller of the Treasury, the State Department of Assessments and Taxation, and the Department of Labor, Licensing and Regulation (DLLR), and all other taxing authorities, as applicable, and will have paid all withholding taxes due to the State of Maryland prior to final settlement.

C.AFFIRMATION REGARDING BRIBERY CONVICTIONS: I FURTHER AFFIRM THAT neither I, nor to the best of my knowledge, information, and belief, the above business, (as defined in §16-101(b) of the State Finance and Procurement Article of the Annotated Code of Maryland), nor any of its officers, directors, or partners, nor any of its employees directly involved in obtaining or performing contracts with the public bodies (as defined in §16-101(f) of the State Finance and Procurement Article of the Annotated Code of Maryland), has been convicted of, or has had probation imposed pursuant to §§6-221 and 6-222 of the Criminal Procedure Article, Annotated Code of Maryland, as may be amended from time to time, or has had probation before judgment pursuant to Criminal Procedure Article, §6-220, Annotated Code of Maryland, as may be amended from time to time, or has pleaded nolo contendere to a charge of, bribery, attempted bribery, or conspiracy to bribe in violation of Maryland law, or of the law of any other state or federal law, except as follows [indicate the reasons why the affirmation cannot be given and list any conviction, plea, or imposition of probation before judgment with the date, court, official or administrative body, the sentence or disposition, the name(s) of the person(s) involved, and their current positions and responsibilities

withthebusiness]:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

D.AFFIRMATION REGARDING OTHER CONVICTIONS: I FURTHER AFFIRM THAT neither I, nor to the best of my knowledge, information, and belief, the above business, or any of its officers, directors, members, or partners, or any of its employees directly involved in obtaining or performing contracts with public bodies, has:

(a)been convicted under the state or federal statute of a criminal offense incident to obtaining, attempting to obtain, or performing a public or private contract, fraud, embezzlement, theft, forgery, falsification or destruction of records, or receiving stolen property;

(b)been convicted of any criminal violation of a state or federal antitrust statute;

(c)been convicted under the provisions of Title 18 of the United States Code for violation of the Racketeer Influenced and Corrupt Organization Act, 18 U.S.C. §§1961, et seq., or the Mail Fraud Act, 18 U.S.C. §§1341, et. seq., for acts arising out of the submission of bids or proposals for a public or private contract;

(d)been convicted of a violation of the State Minority Business Enterprise Law, Section 14-308 of the State Finance and Procurement Article of the Annotated Code of Maryland;

(e)been convicted of conspiracy to commit any act or omission that would constitute grounds for conviction or liability under any law or statute described in subsection (a), (b), (c), or (d) above;

(f)been found civilly liable under a state or federal antitrust statute for acts or omissions in connection with the submission of bids or proposals for a public or private contract;

(g)admitted in writing or under oath, during the course of an official investigation or other proceeding, acts or omissions that would constitute grounds for conviction or liability under any law or statute described above, except as follows [indicate reasons why the affirmations cannot be given, and list any conviction, plea, or imposition of probation before judgment with the date, court, official or administrative body, the sentence or disposition, the name(s) of the person(s) involved and their current positions and responsibilities with the business,

and the status of any debarment]: _____________________________________________

___________________________________________________________________

E.AFFIRMATION REGARDING DEBARMENT: I FURTHER AFFIRM THAT neither I, nor to the best of my knowledge, information, and belief, the above business, or any of its officers, directors, members, or partners or any of its employees directly involved in obtaining or performing contracts with public bodies, has ever been suspended or debarred (including being issued a limited denial of participation) by any public entity, except as follows [list each debarment or suspension providing the date of the suspension or debarment, the name of the public entity and the status of the proceedings, the name(s) of the person(s) involved and their current positions and responsibilities with the business, the grounds for the debarment or suspension, and the details of each person's involvement in any activity that formed the grounds for the debarment or suspension, and the details of each person's involvement in any activity that formed the grounds for the debarment or suspension]:______________________________________________________________________

Affordable Housing Trust shall not knowingly approve grants of financial or technical assistance to recipients who are engaged in discriminatory employment practices.

H.The Secretary's Minority Business Enterprise Program which establishes a program to provide opportunities for minority contractors and vendors to participate in Department of Housing and Community Development Programs; and the minority business enterprise plan submitted by or on behalf of Project Sponsor as approved by the Department of Housing and Community Development's Equal Opportunity Officer, provided, however, that this Paragraph H shall not apply in the event that a statement is attached hereto from the Project Sponsor's equal opportunity officer stating that the general contractor is in compliance with local minority business participation programs or objectives.

I.The Department of Housing and Community Development's Relocation Policy where

applicable.

J.All other related applicable Federal and State laws, regulations and rules.

THE PROJECT SPONSOR HEREBY GIVES ASSURANCE THAT it will immediately take any measures to effectuate this agreement.

THIS ASSURANCE is given on the date below, in consideration of and for the purpose of obtaining and shall continue for the period of any State financial or technical assistance extended after the date hereof to or on behalf of the Project Sponsor by the Maryland Affordable Housing Trust. The Project Sponsor recognizes and agrees that such State financial or technical assistance will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Project Sponsor, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Project Sponsor.

[Name and Title should match Name/Title of a person authorized by the Corporate Resolutions and Incumbency Certificate]

Date: ___________________________________

MARYLAND AFFORDABLE HOUSING TRUST

ASSURANCE OF COMPLIANCE

WITH EEO, CIVIL RIGHTS, DRUG AND ALCOHOL FREE

WORKPLACE, AND OTHER REQUIREMENTS

THE PROJECT SPONSOR IDENTIFIED ABOVE HEREBY AGREES THAT IT WILL COMPLY WITH:

A.Title VI of the Civil Rights Act of 1964 (the "Act"), as amended, to the end that, in accordance with Title VI of the Act, no person in the United States shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Project Sponsor receives financial or technical assistance from the Maryland Affordable Housing Trust.

B.Title VII of the Civil Rights Act of 1964, as amended, to the end that, in accordance with Title VII of that Act, it shall be an unlawful employment practice for an employer:

1.to fail or refuse to hire or to discharge any individual, or otherwise discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment, because of such individual's race, color, religion, sex or national origin;

2.to limit, segregate, or classify his employees or applicants for employment in any way which would deprive or tend to deprive any individual of employment opportunities or otherwise adversely affect his status as an employee because of such individual's race, color, religion, sex, or national origin.

C.Title VIII of the Civil Rights Act of 1968, as amended, to the end that, it is the policy of the United States to provide, within constitutional limitations, for fair housing throughout the United States.

D.The Fair Housing Amendments Act of 1988, as amended (the "Fair Housing Amendments Act"), to the end that it shall be unlawful to discriminate against any person in the terms of the rental of a dwelling because of the familial status except with respect to "housing for older persons" (as defined in the Fair Housing Amendments Act).

E.Title 20 of the State Government Article of the Annotated Code of Maryland, as amended, which establishes the Commission on Human Relations and prohibits discrimination in employment and residential housing practices.

F.State of Maryland Executive Order 01.01.2007.16 relating to drug and alcohol free workplaces for non-State entities, promulgated August 22, 2007.

G.The Americans with Disabilities Act of 1990, as amended.

H.The Secretary of the Department of Housing and Community Development of the State of Maryland's (the "Secretary") Policy Statement on Equal Opportunity, to the end that, the Maryland Affordable Housing Trust shall not knowingly approve grants of financial or technical assistance to recipients who are engaged in discriminatory employment practices.

I.The Secretary's Minority Business Enterprise Program which establishes a program to provide opportunities for minority contractors and vendors to participate in Department of Housing and Community Development Programs; and the minority business enterprise plan submitted by or on behalf of Project Sponsor as approved by the Department of Housing and Community Development's Equal Opportunity Officer, provided, however, that this Paragraph H shall not apply in the event that a statement is attached hereto from the Project Sponsor's equal opportunity officer stating that the general contractor is in compliance with local minority business participation programs or objectives.

J.The Department of Housing and Community Development's Relocation Policy where

applicable.

K.All other related applicable Federal and State laws, regulations and rules.

THE PROJECT SPONSOR HEREBY GIVES ASSURANCE THAT it will immediately take any measures to effectuate this agreement.

THIS ASSURANCE is given on the date below, in consideration of and for the purpose of obtaining and shall continue for the period of any State financial or technical assistance extended after the date hereof to or on behalf of the Project Sponsor by the Maryland Affordable Housing Trust. The Project Sponsor recognizes and agrees that such State financial or technical assistance will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Project Sponsor, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Project Sponsor.

[Name and Title should match Name/Title of a person authorized by the Corporate Resolutions and Incumbency Certificate]

Date: ___________________________________

ACCESS TO PUBLIC RECORDS ACT NOTICE AND WAIVER

Applicants should give specific attention to the identification of information furnished to the Maryland Affordable Housing Trust (MAHT) under this application which they deem confidential, commercial or financial information, proprietary information, or trade secrets and provide any justification of why this information should not be disclosed under the Maryland Access to Public Records Act, State Government Article, Part III, §§10-611 through 10-628 of the Annotated Code of Maryland. Applicants are advised that, upon request from a third party, MAHT is required to make an independent determination as to whether the information may or must be divulged to that party.

This information will be disclosed to appropriate staff of MAHT or to public officials for purposes directly connected with the administration of the programs for which its use is intended. Such information may be shared with State, Federal or local government agencies that have a financial role on the project.

MAHT intends to make available to the public certain information regarding projects recommended for funding by MAHT. Some of this information may not be disclosed under Maryland’s Access to Public Records Act. By signing and delivering this application to MAHT, you hereby AGREE TO WAIVE ANY RIGHTS TO OBJECT TO OR PREVENT THE DISCLOSURE TO THE PUBLIC OF THE FOLLOWING INFORMATION: Grantee’s/Borrower’s name; name and location of the project; grant or loan amount and terms; amounts and source of other financing; public purpose of the grant or loan; county in which the project is located; a description of the project including the number of units and number of units set aside for the public purpose.

IN WITNESS WHEREOF, the applicant has caused this document to be duly

(Full legal name of applicant)

Signature:

Name:

Title: