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Grant for Legislatively-named Municipality FY19: Updated November 2018 13 <br />This section to be completed by Grantee’s Authorized Representative (AR): <br />I certify that we will maintain an adequate Conflict of Interest Policy, and throughout the term of our <br />agreement, we will monitor and report any actual, potential, individual, or organizational conflicts of interest to <br />the State’s Authorized Representative. <br />I also certify that I have read and understand the description of conflict of interest above and as of this date <br />(check one of the two boxes below): <br /> I do not have any conflicts of interest relating to this project. <br /> <br /> I have an actual, potential, individual, or organizational (indicate below) conflict of interest. The nature of <br />the conflict is as follows: <br />If at any time during the grant project I discover a conflict of interest, I will disclose that conflict immediately to <br />the State’s Authorized Representative. <br />Grantee AR’s Printed Name: Date: <br />Grantee AR’s Signature: <br />Organization Name: _____________________________________________________________ <br />Project Name: __________________________________________________________________ <br /> <br />Legal Citation: ML______, Chapter ______, Article ___, Section ___, Subdivision ____ <br />--------------------------------------------------------------------------------------------------------------------------------- <br />State AR’s Printed Name: ________________________________ Date: <br />State AR’s Signature: ____________________________________ <br /> <br /> <br />DocuSign Envelope ID: 065F83CA-61C8-441A-99AB-0093E546627C <br />GR Rafferty <br />none <br /> <br />City of Lino Lakes <br /> <br />2021 Preparing for EAB Grant <br />December 14, 2021