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23 <br />RESPONDER'S CERTIFICATION FORM <br />I have carefully examined the Request for Qualifications, the sample Agreement for Design Consultant <br />Services and any other documents accompanying or made a part of this Request for Qualification. <br />I hereby propose to furnish the professional design consultant services for Orange County in accordance with <br />the instructions, terms, conditions, and requirements incorporated in this Request for Qualification. I certify <br />that all information contained in this response is truthful to the best of my knowledge and belief. I further certify <br />that I am duly authorized to submit this response on behalf of the firm as its act and deed and that the firm is <br />ready, willing and able to perform if awarded the contract. <br />NAME OF FIRM: <br />BY: (printed name) <br />SIGNATURE: <br />MAILING ADDRESS: <br />CITY /STATE/ZIP CODE: <br />TELEPHONE NUMBER: <br />FAX NUMBER: <br />ACKNOWLEDGEMENT OF ADDENDA <br />Responder hereby acknowledges receipt of all Addenda through and including: <br />Addendum No. Date Acknowledgement <br />Page 8of10 <br />