98-24 Exhibits to the Agreement for the Operation of the Recycling Center - 2024.pdf

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN - CONTINUED Name: ____________________Relationship to Bidder ________________________ Description of Activities_________________________________________ ______________________________________________________________________________ Duration of Engagement___________________ Anticipated Cessation Date: _________ Bidder Contact Name_________________________ Contact Phone Number________________ Certification: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person or entity. I acknowledge that Township of West Orange is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with Township of West Orange to notify the Township in writing of any changes to the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with Township of West Orange, New Jersey and that the Township at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print) ___ _________ Signature: _____________________________ Title_____________________ Date: ________________________ ____ Date: _____________________________ 61