Orange County NC Website
Browse       Search
DocuSign Envelope ID: 7796CD94- 342E- 40D0- B7C3- A2B604F926B4 <br />ORANGE COUNTY Department of Solid Waste Management <br />System Proposal Request No: XXXX <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 <br />that: <br />(1) He or she is fully informed regarding the preparation and contents of the attached Proposal and <br />of all pertinent circumstances regarding, such Proposal; <br />(2) Neither he /she, nor any official, agent or employee of the vendor has entered Into any <br />agreement, participated In any coliusion, or otherwise taken any action which Is in restraint of <br />free competition in connection with this proposal; and <br />SIGNATURE OF PROPOSER - -- — -- — — <br />- - - - -- - - (Print full name of corporation) - - — <br />(Address - County- State - Zip Code) <br />Attest -- <br />(Secretary /Assistant Secretary) <br />By: - <br />President /Vice President /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 this clay of, 2016 <br />Title <br />My Commission Expires <br />ATTACHMENT E IRAN [DIVESTMENT ACT CERTIFICATION <br />Required By N.C.G.S. <br />23 <br />RFP No. 5427 <br />