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—� —. —e <br />EXEC UTION <br />In compliance with this Request for Bids, and subject to all the conditions herein, the undersigned offers and agrees to <br />furnish and deliver any or all items upon which prices are bid, at the prices set opposite each item within the time specified <br />herein. By executing this bid, I certify that this bid is submitted competitively and without collusion (G.S. 143 -54), that none of <br />our officers, directors, or owners of an unincorporated business entity has been convicted of any violations of Chapter 78A of <br />the General Statutes, the Securities Act of 1933, or the Securities Exchange Act of 1934 (G.S. 143 - 59.2), and that we are not <br />an ineligible vendor as set forth in G.S. 143 -59.1. False certification is a Class I felony. <br />Failure to execute /sign bid prior to submittal shall render bid invalid. Late bids are not acceptable. <br />OFFEROR: — <br />I `(c�T <br />EDERAL ID R SOCIAL SECURITY NO. <br />cs <br />6 2 <br />STREET i DD � � ,� v. <br />P.O. BOX: <br />ZIP: <br />C STATE & g I Q� N C, <br />TEb PH <br />c � ` � <br />TOLL FREE TEL NO <br />TYPE OR PRINT NAME &TITLE OF PERSON SIGNING: q j P� � <br />® <br />w T <br />`� �� � <br />AUTHORIZED SIGNATURE: <br />DATE: ^' <br />E -MAIL: <br />If you desire to "no bid" this requirement, sign and return only this page, check appropriate box(es). <br />( ) NO BID ( ) REMOVE FROM MAILING LIST <br />Offer valid for 45 days from date of opening unless otherwise stated here: days (See Instructions for Bids, Item 6) <br />Prompt Payment Discount: % days (See Instructions for Bids, Item 7) <br />ACCEPTANCE OF BID <br />If any or all parts of this bid are accepted by Cabarrus County, an authorized representative of Cabarrus County shall affix their signature <br />hereto and this document and the provisions of the Instructions for Bids, the special terms and the conditions specific to this Request for <br />Bid, the specifications, and the Cabarrus County General Contract Terms and Conditions shall then constitute the written agreement <br />between the parties. A copy of this acceptance will be forwarded to the successful offeror(s). <br />FOR CABARRUS COUNTY USE ONLY <br />Offer accepted and contract awarded this day of , 20 , as indicated on attached certification, by <br />(Authorized representative of Cabarrus County). <br />Attachment number 2 \n <br />F -10 Page 211 <br />