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DocuSign Envelope ID: E53DCC3C-B8E8-410C-BB50-A039C27BD393 <br /> ATTACHMENT D- EXECUTION OF PROPOSAL <br /> Project Name: HHW & OFOA Collection & Processing <br /> System Proposal Request No: 5255 <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 collusion, 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 /> PresidentJVice President/Assistant Vice President.} <br /> Printed: <br /> Title: <br /> CORPORATE SEAL: <br /> Federal ID. or Social Security Number__. <br /> NOTE-AFFIDAVIT MUST OE NOTARIZED <br /> Subscribed and sworn to before me this day of_ 2016 <br /> My Commission Expires <br /> Title <br /> 23 <br /> RFP No.xxxx <br />