1-RFQ-FP-03-2526 Grant Coordinator Services Contact Affidavit Fillable.pdf

1996 South Kirk Road, Suite 320, Geneva, Illinois 60134

PART I – CONTACT INFORMATION

The undersigned, as Proposer, declares to have fully examined the Request for Proposal and Scope of Services for the designated project, all of which are submitted and on file electronically via Bonfire with the Forest Preserve District of Kane County located at 1996 S. Kirk Road, Suite 320, Geneva, Illinois 60134, and all other documents referred to or mentioned in the RFQ Documents, including all Addenda issued thereto;

Further, the undersigned proposes and agrees if this Proposal is awarded by the District, to execute and fully perform the work required under this Document.

Name of Agency/Firm ________________________________________________

Contact Person ________________________________________________

Signature ________________________________________________

Title ________________________________________________

Main Business Address ________________________________________________

City, State, Zip Code ________________________________________________

Telephone Number ________________________________________________

Fax Number ________________________________________________

Email Address ________________________________________________

Employer Identification # ________________________________________________

Bill Lenert, President Benjamin Haberthur, Executive Director

(630) 232-5980 Fax: (630) 232-5924 www.kaneforest.com

RFQ-FP-03-2526

PART II - AFFIDAVIT / CERTIFICATION

State of ________________________)

County of _______________________)

The undersigned being duly sworn, certifies that he/she is (complete one of the following):

a. Sole Proprietor of _________________________________________________ (Name of firm)

b. A Partner of the Partnership d/b/a _____________________________________ (Name of Partnership)

c. An Officer of _____________________________________________________ (Name of Corporation)

d. The Manager of ___________________________________________________ (Name of Limited Liability Company)

Hereinafter called the Proposer and that; if Proposer is an entity described above, the following names and titles are true and correct as of the date hereof:

(President or Partner or Member) (Vice President or Partner or Member)

(Secretary or Partner or Member) (Treasurer or Partner or Member)

The undersigned certifies and warrants that he/she is duly authorized to execute this certification/affidavit on behalf of the Proposer and in accordance with the organizational documents of the Proposer and the laws of the State of Illinois and that this certification is binding upon the Proposer and is true and accurate. Further the undersigned certifies that the Proposer is not barred from Proposer on this project as a result of a violation of either 720 Illinois Compiled Statutes 5/33 E-3 or 5/33 E-4, Bid-rigging or Bid-rotating.

The affiant deposes and says that he/she has examined and carefully prepared this Proposal from the Contract Documents and that the statements contained herein are true and correct and that this proposal is made without collusion with any other person, firm or corporation.

If a Corporation, the undersigned further certifies that the recitals and resolutions attached hereto and made a part hereof were unanimously adopted by the Board of Directors of the Corporation at a meeting of said Board of Directors duly called and held and have not been repealed, nor modified and that the same remain in full force and effect. (Attach a copy of the corporate resolution granting the individual executing the contract documents authority to do so.)

Signature and Title

CORPORATE SEAL (if available) Business Address

City and State

Phone

Fax

Subscribed and sworn to before me this ______ day of ______________ AD, 2025.

_________________________________ My Commission Expires: _____________ Notary Public