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EXECUTION OF PROPOSAL <br />PROJECT NAME: <br />HOUSEHOLD HAZARDOUS WASTE COLLECTIONPROPOSAL REQUEST NO. 236 <br />THIS PAGE MUST BE FULLY EXECUTED AND SIGNED FOR THE PROPOSAL TO BE CONSIDERED. <br />The person executing the proposal, on behalf of the vendor, being first duly sworn, deposes and says that: <br />(1) He is fully informed regarding the preparation and contents of the attached Proposal and of all <br />pertinent circumstances regarding such Proposal; <br />(2) Neither he, nor any official, agent or employee of the vendor has entered Into any agreement, <br />participated In any collusion, or otherwise taken any action which is in restraint of free competition in <br />connection with this proposal; and <br />SIGNATURE OF PROPOSAL <br />Attest _ <br />By: <br />Printed: <br />Title: <br />(Print full name of corporation) <br />(Address - County- State - Zip Code) <br />(Secretary /Assistant Secretary) <br />President/Vice Pres /Assistant Vice President) <br />CORPORATE SEAL: <br />Federal ID. or Social Security Number. <br />NOTE - AFFIDAVIT MUST BE NOTARIZED <br />Subscribed and sworn to before me <br />This day of ,2012. <br />Title <br />My Commission Expires <br />Page 17 <br />HHW RFP # 5183 <br />