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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 />FYCeLI_�i�l:��iT�7:I� - • <br />Clean Harbors Environmental Services Inc <br />(Print full name of corporation) <br />208 Watlington Industrial Drive, Reidsville, NC 27320 <br />(A dress - County- State - Zip Code) <br />Attest <br />(Sssr$tap,4Assistant l ecretary) David T. Musselman <br />By: <br />P ident/Vi Pres /Assist nt Vice President) <br />Printed: Joseph L. McNally <br />Title: VP <br />CORPORATE SEAL: <br />f rr <br />Federal ID. or Social Security Number <br />NOTE - AFFIDAVIT MUST BE NOTARIZED <br />Subscribed and sw n to before me <br />This 9th ay f Apri L . ,2012. <br />DAVID PSublicAN <br />% <br />NWEAl1H OF MASSACHUSETTS <br />My commission Expires <br />September 15. 2017 <br />Title <br />My Commission Expires <br />Page 17 <br />HHW RFP # 5183 <br />