Township Council Meeting — Packet

Part 2: Additional Information PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide a detailed, accurate and precise description of the activities of the person or entity, or a parent entity, subsidiary, or affiliate thereof engaging in investment activates in Iran below and, if more space is needed, on additional sheets provided by you. Part 3: Certification of True and Complete Information I, being duly sworn upon my oath, hereby represent and state that the Joregoing information and any attachments there 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. 1 acknowledge that the TOWNSHIP OF WEST ORANGE is relying on the information contained herein and thereby acknowledge that | am under a continuing obligation from the date of this certification through the completion of any contracts with the 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, Irecognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with the TOWNSHIP OF WEST ORANGE and that the TOWNSHIP at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name . (Print) tds Signature Date P-46