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DocuSign Envelope ID:4B2CC4A2-9375-4CA5-B4DF-EB9993ABD639 <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 consultant services for Orange County in accordance with the <br /> 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 <br /> further certify that I am duly authorized to submit this response on behalf of the firm as its act and deed <br /> and that the firm is 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 /> 6 <br />