Attachment A_ Certificate of No Change.pdf

ILLINOIS TOLLWAY

REQUEST FOR PROPOSAL

Contract #25-1089 / Bond Underwriting Services BidBuy Bid Number B-51492

Contract #25-1089 Certificate of No Change Page 1 of 2

CERTIFICATE OF NO CHANGE

Annual Certification of Continued Compliance with RFP / Contract Requirements

Instructions: This Certificate must be completed and submitted annually within 30 days in advance of April 1st, by all firms included in the Tollway’s Pool of Senior Managing Underwriters under Contract #25-1089. Firms must certify that no material change has occurred to the firm or key personnel as defined in the RFP. A material change is considered to be any merger or acquisition resulting in a change to the firm’s legal name or ownership structure; and/or any change to key personnel identified in the firm's proposal as the lead banker or lead underwriter authorized to execute a Bond Purchase Agreement on behalf of their firm. If there has been a material change as described herein, select 'Change' in Section 2 below and complete Section 3.

SECTION 1 — VENDOR AND CONTRACT IDENTIFICATION

Vendor Legal Name:

Address:

Contract Date: Annual Certification Date:

Contract Date is the last dated signature of the parties on the firm’s contract. Annual Certification Date is April 1st of the year in which the firm is making this certification.

SECTION 2 — CERTIFICATION OF NO CHANGE

For each item below, indicate whether the information, representation, or qualification submitted in connection with the original RFP response and/or contract award remains true, complete, and unchanged as of the date of this Certificate.

No. Area of Certification No Change Change (Complete Section 3)

1 MSRB broker-dealer registration status ☐ ☐

2 Firm name or ownership structure ☐ ☐

3 Key personnel identified as lead banker(s)/underwriter(s) ☐ ☐

SECTION 3 — DISCLOSURE OF CHANGES (IF ANY)

Complete this section only if “Change” was checked for one or more items in Section 2. Describe the nature and effective date of each change and attach any supporting documentation. Use additional sheets, if necessary. If no changes occurred, mark this section “N/A.”

Item No. Description of Change Effective Date Supporting Document Attached

☐ Yes ☐ No

☐ Yes ☐ No

ILLINOIS TOLLWAY

REQUEST FOR PROPOSAL

Contract #25-1089 / Bond Underwriting Services BidBuy Bid Number B-51492

Contract #25-1089 Certificate of No Change Page 2 of 2

Item No. Description of Change Effective Date Supporting Document Attached

☐ Yes ☐ No

SECTION 4 — CERTIFICATION STATEMENT

I, the undersigned, being duly authorized to execute this Certificate on behalf of the vendor identified in Section 1 (the “Vendor”), certify that I have read and understand the information previously submitted to the Illinois State Toll Highway Authority (the “Tollway”) in connection with the above-referenced RFP and/or contract, and that, except as disclosed in Section 3 above, such information remains true, complete, and accurate as of the date below.

I understand that the Tollway will rely on this Certificate to confirm the Vendor's continued eligibility and qualification to perform under the contract. I understand that a materially false statement made willfully, fraudulently, or through failure to exercise reasonable diligence in preparing this Certificate may result in disqualification from contract award and termination of the contract.

SECTION 5 — AUTHORIZED SIGNATURE

Signature of Authorized Representative: _______________________________________

Printed Name & Title: _______________________________________

Email Address: _______________________________________

Phone Number: ______________________________

Date: ______________________________

Submission Instructions Any questions regarding this form and all submission materials must be submitted via email directly to:

Debt Management/Finance Department Illinois State Toll Highway Authority Email: debtmanagement@getipass.com