5.1 Public Hearing - Small Cities Development Program

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Signature Page By signing below, the Applicant certifies to the best of their knowledge that the data and information provided in the Application is true and correct. Signature of Authorized Official (Primary Community): Date: Name of Authorized Official: Tyler Gardner, Mayor Signature of Authorized Official (Partnering Community — if applicable): Date: Name of Authorized Official (Partnering Primary Community): NA Signature of Authorized Official (Partnering Community — if applicable): Date: Name of Authorized Official (Partnering Community — if applicable): NA Signature of Primary Administrator: Date: Name of Primary Administrator: Gail M. Leverson, Sr. Funding Specialist, Widseth Signature of Secondary Administrative Entity (if applicable) Date: Name of Secondary Administrative Entity (if applicable): NA Signature of Engineering firm for Public Facility Projects (if applicable) Date: Name of Engineering Firm (if applicable): Tim Houle, P.E., Widseth 2023 Small Cities Development Program Application Coversheet 3