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["Insurance Commitment Certification"]
["for the"]
[" Public Assistance Disaster Program"]
[]
[]
[]
["Disaster Name and Number:"]
[]
[]
["(Name of Applicant)"]
[]
[]
["I",{"$nulls":4},", certify that "]
[null,"(Name)",{"$nulls":4},"(Community or Agency)"]
[]
["hereby commits to purchase and maintain insurance on                                                                     for the hazard "]
[{"$nulls":4},"                                                                  (Name of Damaged Facility)",null,null,"  (Name of Damaged Facility)"]
[]
["for the hazard that caused the damage and that the amount of the insurance coverage will, at a minimum, "]
[]
["be in the amount of the estimated eligible project costs for that facility prior to any reduction."]
{"$rows_empty":7}
["Typed Name and Title of Certifying Official"]
[]
[]
[]
[]
["Certifying Official's Signature *",{"$nulls":9},"Date"]
[]
[]
[]
["*","Certifying Official must be one of the Agents listed on the Designation of Applicant's Agent"]
["form (DHS&EM FORM 30-5)"]

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