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DocuSign Envelope ID: D488A41DA-6COC-41`1 F-A676-98CFE932E2135 <br /> r <br /> RESPONDER'S CERTIFICATION FORM <br /> I have carefully examined the Request for Qualifications, the sample Agreement for Design Consultant <br /> Services and any other documents accompanying or made a part of this Request for Qualification. <br /> I hereby propose to furnish the professional design consultant services for Orange County in accordance with <br /> the instructions, terms, conditions, and requirements incorporated in this Request for Qualification. I certify <br /> that all information contained in this response is truthful to the best of my knowledge and belief. I further certify <br /> that I am duly authorized to submit this response on behalf of the firm as its act and deed and that the firm is <br /> ready, willing and able to perform if awarded the contract. <br /> NAME OF FIRM: <br /> BY: (printed name) <br /> SIGNATURE: <br /> MAILING ADDRESS: <br /> CITY/STATE/ZIP CODE: <br /> TELEPHONE NUMBER: <br /> FAX NUMBER: <br /> ACKNOWLEDGEMENT OF ADDENDA <br /> Responder hereby acknowledges receipt of all Addenda through and including: <br /> Addendum No. Date Acknowledgement <br /> Page 5 of 9 <br />