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65 <br />0 Affidavits & Forms <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: The Freelon Grou <br />BY: (printed name) Derek Jones <br />SIGNATURE: <br />MAILING ADDRESS: 5310 South Alston Ave. Suite 320 <br />CITY /STATE /ZIP CODE: Durham, NC 27713 <br />TELEPHONE NUMBER: 919.941.9790 <br />FAX NUMBER: 919.767.0144 <br />ACKNOWLEDGEMENT OF ADDENDA <br />Responder hereby acknowledges receipt of all Addenda through and including: <br />Addendum No. Date Acknowledgement <br />1 12/03/2013 <br />30 t= REELON I Southern Branch Library Facilitator Proposal <br />