261-25 Cerbo Submission.pdf

Part 2: Additional Information SE PR EFURTI TI ATED TO INVEST! C SIN TRAN. ‘You must provide a detailed, accurate and precise description of the activities of the person or entity, ora parent entity, subsidiary, or affiliate thereof engaging in investment activates in Itan below and, if more space is needed, on additional sheets provided by you. Part 3: Certification. of Tra é and Complete Information - Ld being duly sworn upon. my oath, hereby represent and state that the foregoing information and.any- ailachments there to the best of my knowledge are.true and. complete. J attest that Tam authorized to ‘execute this. certifi if jeation on behalf. of! the above-referenced. Person. or entity. f acknowledge that the ‘Naitie of Contractitig Unit i is. relying on the inforiation ‘conitatned havin - and-thereby-acknowledge-ihat-T-am- through the completion of any contracts with the Reference to Contracting. Unit to notify the Reference to Contracting Unit in writing: of | any. changes to the answers of information contained herein. oD. acknowledge thai “Lam: aware. that. it isa eriminal offense to: make: a false ‘statement or misrepresentation in this cert ification, dnd if | do so, recognize that Lam subject to eriminal prosecution under the law and thas it will also: constitute a ‘material bréach of my agreement(s) with the Namie of Contracting Unit and that the Reference to Contracting Unit at its option may deelare. any contract(s) resulting. Jeom this certification void-and unenforceable, Full Name (Print) Cy ath aCe aR a. Title vA 0. Signature Cath ld gm Date Y- Bias C. 97 aS: certification