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<br />CIlSC-5, Page 4 <br /> <br />. <br /> <br />IX. PARTICIPANT(S) CERTIFICATION AND SICNATURE. <br /> <br />. <br /> <br />.~'. ~ ~ '. <br />. ,', <br /> <br />Each underSigned participant certifies that he/she has reviewed the provisions <br />of this 0&11 agreemen t and agrees to the terms of this agreemen t. <br /> <br />of Pat"ticipant <br />1 - <br /> <br /> <br />:7 . 11)~ <br />, L-7'11 L{ vi <br /> <br />X. COUNTY ASC COMMITTEE (COC). <br /> <br />______6-z:-t-cf:;o');o( t7./~,,~/.o.-.:;_{ <br />Signature of COC Person <br /> <br />Date <br /> <br />,s-I.'; (/3 <br />. <br /> <br />Name of Participant <br /> <br />Date <br /> <br />( <br /> <br />. ''j' <br />O)'j - - 0 ')' - 3 <br />Date <br />