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DocuSign Envelope ID: 04E136D1 -507C- 4219- BF16- 446F8D2192F8 <br />Orange County Detention Facility, Environment & Agriculture Center & Park Operations Base <br />Request for Qualifications (RFQ #5249) <br />•: r <br />AFFIDAVIT A <br />Certification Form <br />(Provide separate Certification for each Joint Venture or Partnership entity) <br />Bordeaux Construction Company, Inc. <br />* *SEAL ** <br />I HEREBY CERTIFYTHATTHE INFORMATION CONTAINED IN THIS RESPONSETOTHE REQUEST FOR QUALIFICATIONS IS <br />CORRECT AND TRUTHFUL TO THE BEST OF MY KNOWLEDGE AND BELIEF. <br />This the 23rd day of May 2018 <br />0 <br />J. Blair Bordeaux, P.E. <br />Title: President <br />License number under which the project will be executed: 9266 <br />Name license number above is held in: <br />STATE OF NORTH CAROLINA <br />COUNTY OF DURHAM <br />I, Santita R. Rose a Notary Public in and for the County and State aforesaid, do hereby certify that <br />J. Blair Bordeaux personally came before me this day and acknowledged that he is of and <br />by that authority duly given and as an act of the foregoing instrument was signed by as, attested by him /herself as <br />Secretary, and sealed with the common seal of said corporation. <br />IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal this 23rd day of May 2018. <br />Notary Public: Santita R. Rose <br />My commission expires: 11/11/2018 <br />CY1 <br />