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DocuSign Envelope ID: 7796CD94- 342E- 40D0- B7C3- A2B604F926B4 <br />ORANGE COUNTY <br />Department of Solid Waste Management <br />System Proposal Request No: XXXX <br />THIS PAGE MUST BE FULLY EXECUTED AND SIGNET] FOR THE PROPOSAL TO BE CONSIDERED <br />The person executing the proposal, on behalf of the vendor, being first duty 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 d cumstances regarding such Proposal; <br />(2) Neither he,Jshe, nor any official, agent or employee of the vendor has entered Into any <br />agreement, participated In any collusion, or otherwise taken any action which 1s in restraint of <br />free competition in, connectlon with this proposal; and <br />SIGNATURE OF PROPOSER <br />r <br />(Print full name of corporation) <br />e <br />� <br />,� �µ ' <br />(Address . Cau+tty- State - Zip C�de) <br />AtteSl � r <br />(5 retaryJ�lssistilrrt Secretary) <br />By: r _ <br />I'r sid et ice Presldentf s5istant Vice President) <br />Title: <br />CORPORATE SEAL.- <br />Federal ID. or SONZl Security Number -56 — 16 9--� 1 <br />NOTE- AFFIDAVIT MUST BE NOTARIZED <br />grit A6 <br />Subscribed and sworn to before rare this _�� � day of old7t <br />MV C on i n i Isis ion Expires .�_.l ❑ <br />Tf le <br />ATTACHMENT E IRAN DIVESTMENT ACT CERTIFICATION <br />Required By N.C.G.S. <br />23 <br />RFP No. 5427 <br />