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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 /> • <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 /> Clean Harbors Environmental Services,Inc, <br /> (Print full name of corporation) <br /> 208 Watlington Industrial Drive,Reidsville,NC 27320 <br /> (A dress -County-State-Zip Code) <br /> ( Attest <br /> (SecretarylAssistant ecretary) David T.Musselman <br /> By: <br /> P -sidentNi - PresfAssist•,nt Vice President) <br /> Printed: Joseph L.McNally � ; <br /> Title: VP '', `, t„�•. . <br /> _ f yl F a <br /> • CORPORATE SEAL: • 0-) }i <br /> • <br /> Federal ID. or Social Security Number 04-269-8999 l r +` • <br /> NOTE-AFFIDAVIT MUST BE NOTARIZED <br /> Subscribed and swo n tabefore me <br /> This 9th �•ay �.f . ,2012. <br /> DAVID T. MUSSELMAN <br /> Y w - Notary Public <br /> 1 tiQMMONWEAIIHOFMASSACHUSETTS <br /> ,9 My Commission Expires <br /> Seplember 16, 2017 <br /> Title <br /> My Commission Expires <br /> Page 17 <br /> HHW RFP#5183 <br /> • <br /> • <br />