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DocuSign Envelope ID:41 B27956-1 C1 7-475E-9558-D6D38ABE1436 <br /> RESPONDER'S CERTIFICATION FORM <br /> I have carefully examined the Request for Qualifications, the sample Agreement for Design <br /> Consultant Services and any other documents accompanying or made a part of this Request for <br /> Qualification. <br /> I hereby propose to furnish the professional design consultant services for Orange County in <br /> accordance with the instructions, terms, conditions, and requirements incorporated in this Request for <br /> Qualification. I certify that all information contained in this response is truthful to the best of my <br /> knowledge and belief. I further certify that I am duly authorized to submit this response on behalf of <br /> the firm as its act and deed and that the firm is ready, willing and able to perform if awarded the <br /> contract. <br /> NAME OF FIRM: HH Architecture, PA <br /> Kristen M. Hess, AIA, LEED AP <br /> BY: (printed name) President, Principal <br /> SIGNATURE: <br /> MAILING ADDRESS: 520 S. Harrington Street <br /> CITY/STATE/ZIP CODE: Raleigh, NC 27601 <br /> TELEPHONE NUMBER: 919.828.2301 <br /> FAX NUMBER: 919.828.2303 <br /> ACKNOWLEDGEMENT OF ADDENDA <br /> Responder hereby acknowledges receipt of all Addenda through and including: <br /> Addendum No. Date Acknowledgement <br /> 1 9/3/2015 <br /> Page 10 of 12 <br />