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DocuSign Envelope ID:813A5323-29B6-4DDD-A2B8-22B7F4A4A68C <br /> 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 /> SIGNATURE OF PROPOSAL <br /> • <br /> (Print full name of corporation) <br /> (Address -County-State-Zip Code) <br /> Attest <br /> (Secretary/Assistant Secretary) <br /> By, <br /> PresidentNice Pres/Assistant Vice President) <br /> Printed: <br /> Title: <br /> CORPORATE SEAL: <br /> Federal ID. or Social Security Number <br /> NOTE -AFFIDAVIT MUST BE NOTARIZED <br /> Subscribed and sworn to before me <br /> This day of ,2012. <br /> Title <br /> My Commission Expires <br /> Page 17 <br /> HHW RFP#5183 <br />