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Local Assistance Procedures Manual <br />Exhibit 10 -G Certification of Local Agency <br />CERTIFICATION OF LOCAL AGENCY <br />I HEREBY CERTIFY that I am the <br />EXHIBIT 10 -G <br />Certification of Local Agency <br />of the <br />(local agency) I , and that the consulting firm of <br />,or its representative has not been required (except <br />as herein expressly stated), directly or indirectly, as an express or implied condition in connection <br />with obtaining or carrying out this Agreement to: <br />(a) employ, retain, agree to employ or retain, any firm or person, or <br />(b) pay or agree to pay, to any firm, person or organization, any fee, contribution, donation, or <br />consideration of any kind. <br />I acknowledge that this Certificate is to be made available to the California Department of Transportation <br />(Caltrans) in connection with this Agreement involving participation of federal-aid highway funds, and is <br />subject to applicable state and federal laws, both criminal and civil. <br />(Date) <br />(Signature) <br />Page 10 -45 <br />LPP 06 -02 May 1, 2006 <br />