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DocuSign Envelope ID: D488A4DA-6COC-4F1F-A676-98CFE932E2B5 <br /> F <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. 1 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: Stewart-Cooper-Newell Architects, PA <br /> BY: (printed name) Ken Newell, AIA, LEED AP <br /> SIGNATURE: <br /> MAILING ADDRESS: 719 East Second Avenue <br /> CITY/STATE/ZIP CODE; Gastonia, NC 28054 <br /> TELEPHONE NUMBER: 704.865.6311 <br /> FAX NUMBER, 704.865.0046 <br /> ACKNOWLEDGEMENT OF ADDENDA <br /> Responder hereby acknowledges receipt of all Addenda through and including: <br /> Addendum No. Date Ac vvl dgement <br /> 1 7/19/13 <br /> Page 8 of 9 <br />