CCDF2026-01_ADDENDUM_1.pdf

COUNTY COMMISSIONERS OF CAROLINE COUNTY

OFFICE OF FINANCE

109 MARKET STREET, ROOM 132

DENTON, MARYLAND 21629

410-479-5845 FAX 410-479-4060

CCDF2026-01 BANKING SERVICES

ADDENDUM # 1

Q & A

1. Does the Confiscation Fund need to be a savings account?

a. No, it can be a checking or savings account as long as it is interest-bearing.

2. Would the County be opposed to a low to no-interest account for a flat account fee? (Danny, might need better clarification)

a. Yes, as long as the potential cost benefit is clearly shown and articulated in the bid document.

3. Are there checks written out of the Law Library, Drug Task Force, Inmate, and Tax Sale accounts?

a. The Inmate and Tax Sale are the only two that have any regular checks issued out of them. The other two, we only do internal transfers on

BID AFFIDAVIT CHANGES

1. Moved STOP PAYMENTS to the General Fund

2. Removed INTEREST: SWEEP and INTEREST: RETURN ITEMS (Returned was already under General Fund)

3. Added the word Vendors after 90 for ACH & Natcha

4. Changed ACH Debits (9) to ACH- BATCH OF DEBITS (6)

5. Removed SWEEP MONEY under ESTIMATED MONTHLY

NOTES:

1. County REQUIRES RDC (Remote Deposit Capture)

2. County REQUIRES online access to online statements and cleared checks without filing a request

PLEASE WRITE LEGIBLY. WE WILL NOT BE RESPONSBLE FOR NOT RECEIVING EMAILS IF WE CAN'T READ YOUR ADDRESS

PLEASE LEAVE A BUSINESS CARD IF YOU HAVE ONE

Bid # Bid Name

Company Name Representative

Company Name Representative

Caroline County Finance Department

CCDF2026-01

Banking Services

Email:

Email: ABBY.GRAVES@SHOREUNITEDBANK.COM

DANIELLE.FORREST@SHOREUNITEDBANK.COM

SHORE UNITED BANK ABBY GRAVES

SHORE UNITED BANK DANIELLE FORREST

PROPOSAL

CAROLINE COUNTY DEPARTMENT OF FINANCE

BANKING SERVICES

RFP# CCDF2026-01

Made this ________________________day of _________________________20______

By___________________________________________________________________________

Business Address_______________________________________________________________

The Bidder declares that the only person, firm, or corporation or persons, firms or corporations that have or have any interest in this proposal or in the contract or contracts proposed to be taken is or are the undersigned; that this proposal is made without connection, collusion, or agreement with any person, firm, or corporation making a proposal of the same work to bid a fixed or uniform price; that the attached specifications and form of contract and the drawings therein referred to have been carefully examined and are understood; that as careful an examination has been made as is necessary to become informed as to the character and extent of the work required; and that it is proposed and agreed if the proposal is accepted to contract with Caroline County, Maryland, in the form of contract hereto attached to do the required work in the manner set forth in the specifications and as shown on the drawings.

The prices on the attached and signed Proposal forms are to include and cover the furnishing of all materials and labor requisite and proper (except those specified as being furnished by the Owner), and the providing of all necessary machinery, tools apparatus and means of performing the work, and the doing of all the above-mentioned work, in the manner set forth, described and shown in the specifications, and the contract drawings within the prescribed time. If this proposal shall be accepted by Caroline County, Maryland, and the undersigned shall refuse or neglect within 10 days after receiving the contract for execution, to execute the same and to give the stipulated bond, then said Caroline County, Maryland, may at its sole option, determine that the bidder has abandoned the contract; and thereupon the proposal and the acceptance thereof shall be null and void; and the deposit accompanying the proposal shall be forfeit to and become the property of said Caroline County, Maryland.

PROPOSAL FORM

CAROLINE COUNTY DEPARTMENT OF FINANCE

BANKING SERVICES

County Commissioners of Caroline County, Maryland:

We hereby submit, for your review, our proposal requested by the Invitation to Bid. This proposal includes and incorporates all information as described in this Proposal Form and in Information for Bidders, the same as if specifically written herein.

BIDDER___________________________________________________Date_______________

Business Address_______________________________________________________________

Signature___________________________________________________Phone______________

The Unit Price proposal shall consist of items as listed in Section C.1 on RFP Information for Bidders:

Check this box if you are eligible for in-county preference based on the guidelines in the Caroline County Purchasing Manual: https://www.carolinemd.org/DocumentCenter/View/2949/Caroline-County-

Purchasing-Manual---Adopted-09-05-17?bidId=

The purpose of this Request for Proposal (RFP) is to solicit sealed proposals from qualified banking institutions to establish a contract for Banking Services through competitive negotiations with the COUNTY COMMISSIONERS OF CAROLINE COUNTY, MARYLAND. The banking institution (Offeror) will provide, at a minimum, the basic banking services outlined in the scope of services.

PROPOSAL REQUIREMENTS

The proposal shall provide information necessary for the CAROLINE COUNTY COMMISSIONERS to evaluate the qualifications, experience, and expertise of the proposing bank to perform the requested Banking Services. The Offeror (FINANCIAL INSTITUTION) shall make a written proposal that presents an understanding of the work to be performed. The proposal should address each requirement contained in the Scope of Services (Section 5) and be specific in presenting its qualifications. Proposals should be as thorough and detailed as possible, but written clearly and concisely so that the CAROLINE COUNTY COMMISSIONERS may properly evaluate the bank’s capabilities to provide the required services. The Offeror (FINANCIAL INSTITUTION) should include in their proposal the following:

A completed Proposal Cover Sheet, which is the first page of this RFP (REQUEST FOR

PROPOSAL).

Table of contents. All pages are to be numbered.

Cover Letter/Executive Summary on company letterhead signed by a person with the corporate authority to enter into any contract that results from the RFP (REQUEST FOR PROPOSAL).

A detailed description of the services to be provided that addresses each requirement contained in the Scope of Services (Section 7 on Info for Bidders), including corresponding reports and functionality for each item.

A detailed description of other services and their standard operating procedures that are available in addition to those described in the Scope of Services. Include the cost associated with the setup and ongoing operation of the process.

Provide copies of any supplemental agreements or documents that contain any terms and conditions that will be requested to be incorporated in the overall Agreement (e.g., direct deposit agreement, wire transfer agreement, etc.), including copies of any signature cards that contain terms and conditions. These agreements are an integral part of the resulting contract and will be reviewed by the CAROLINE COUNTY COMMISSIONERS.

The Offeror (FINANCIAL INSTITUTION) shall provide information or a response to the following inquiries:

o The interest rate calculation that would be used for the interest‐bearing accounts and the methodology used to calculate monthly interest earnings.

Provide examples of reports, statements, invoices, or other materials that would be provided to the CAROLINE COUNTY COMMISSIONERS, such as monthly account statements and account analysis statements.

Describe the bank’s senior management commitment to providing the services as included in the proposal. Include a biography or resume of the Officer and key staff to be assigned to this account.

Describe the bank’s approach to account servicing and a description of how the bank monitors client satisfaction.

Provide a list of other Banking relationships similar to Caroline County that would be available to give a reference.

Provide a preliminary work plan in the event of a transition of services.

Describe in detail internal controls used to prevent the loss and/or corruption of electronic transaction processing, including ACH processing, as well as fraud and data security controls that are in place.

The Offeror (FINANCIAL INSTITUTION) shall include its most recent audited financial statements.

The Offeror (FINANCIAL INSTITUTION) shall complete, and include with their proposal, a Pricing Sheet with per-item costs and extended annual costs.

PROPOSAL EVALUATION CRITERIA

Selection of the successful proposal will be based on the submission of proposals meeting the selection criteria. As this is a contract for Professional Services, the grading will not be based solely on price. The minimum selection criteria will include:

A demonstrated understanding of the services to be performed and the completeness and clarity of the Offeror’s (FINANCIAL INSTITUTION) proposal for accomplishing the Scope of Services.

Clearly demonstrated the capacity and resources of the bank to provide the requested services.

The professional competence and qualifications of the Offeror (FINANCIAL INSTITUTION and staff in providing banking services.

Current and past experience in providing similar banking services.

Cost of services.

A local branch presence.

INSTRUCTIONS TO OFFERORS (FINANCIAL INSTITUTIONS)

The proposal must demonstrate that the Offeror (FINANCIAL INSTITUTION) has the resources and capabilities to provide the requested banking services on an “as needed” basis. Offerors (FINANCIAL INSTITUTION) shall submit documentation with their proposal demonstrating compliance with the minimum qualifications.

The following criteria shall be met to be considered under this RFP:

o Depository banks must be Federal or Maryland-chartered banks and Federally insured in the State of Maryland.

o The Offeror (FINANCIAL INSTITUTION) shall provide a similar banking experience to what is currently being provided to the County.

o The Offeror (FINANCIAL INSTITUTION) must have a local branch presence within the County or provide daily pickup service to the Tax Office.

GENERAL FUND Based on Pricing

Monthly Fee

Checks Paid 300 checks

Deposits 30

Remote Deposits 3000

ACH - Credits 90 Vendors

ACH – Batch of Debits 6 a month

ACH - Natcha 90 Vendors

Sweep Fee

Returned Items 2 a month

Stop Payments

ONLINE BANKING

Remote Capture Fee

ACH

ESTIMATED MONTHLY

Interest $25,000,000

Monthly Fee

Sweep Income

The Bidder agrees that this Proposal shall be good and may not be withdrawn for 30 calendar days after the opening of the Bid Proposals.

The bid items listed above are intended to include all work items associated with a complete project, including mobilization. Some work components of the project may not be specifically listed and as such, it is the contractor’s responsibility to include all work required within an appropriate bid item listed above.

Caroline County, Maryland, reserves the right to reject all/any bids and to award the Contract in total or in parts, which, in their opinion, represents the best value and best serves the interest of Caroline County, Maryland.

ALL WORK UNDER THIS CONTRACT SHALL BE CONDUCTED IN COORDINATION WITH, AND AS

DIRECTED BY, THE CAROLINE COUNTY DIRECTOR OF PUBLIC WORKS.

EXPLANATION OF SPECIFIC ITEMS

A. Payment for all material furnished and work done under this Contract shall be made per the unit price bid for each item for the total quantity of the work completed and per all applicable County and State specifications attributable to each bid item. The Contractor shall not be entitled to receive additional compensation for anything furnished or done, except for such extra work authorized in writing by the Engineer.

CONTINGENCY ITEMS

A. Items listed as CONTINGENCY ITEMS in the Proposal may be used and will be paid for only at the written direction and authorization of the Engineer. Contingency items may be selected in place of, or in addition to, the standard bid items. Such selections are to be authorized by the Engineer in writing. All materials furnished and installed shall be in accordance with County and State specifications. Measurements and payment will be in accordance with the proposal and will include, but not necessarily be limited to, the furnishing, hauling, placing, and installing of materials, and the furnishing of such manpower and equipment as required to accomplish the work as directed in writing by the Engineer.

B. Contingency bid items are to be measured and paid for in accordance with the units shown in the Proposal. The contingency item prices shall be applied to compute the value of changes, additions, deletions, and substitutions, which may be made in the work and by order of the engineer. Each unit price shall include the cost for all labor, materials, tools, equipment, overhead, profits, and commissions necessary to complete the item. The stipulated items are defined as follows:

MEASUREMENT AND PAYMENT

Measurement and payment for all work will be per the bid item units.

SUBCONTRACTOR/SUPPLIER LISTING

List all subcontractors/suppliers whose percentage of work is two (2%) or greater. Provide additional pages as necessary. Types of Work not listed indicate that the Contractor intends to perform the work with his/her own force. The Contractor shall not award work to a subcontractor(s) in excess of fifty (50%) percent of the total contract price, without the written approval of Caroline County. Failure of Contractor to list subcontractors may result in the disqualification of the bid.

The following subcontractors/suppliers will be employed by this contract:

No.

Type of Work

Subcontractors Address/Phone

Percent of Work

The following pages of forms, affidavits, and information shall be completed and provided with the submitted bid:

Drug Abuse Policy in Effect (Circle One) YES NO

Insurance certificate attached (Circle One) YES NO

Signature form executed? (Circle One) YES NO

References for Similar Work (Need 3) YES NO

Initialed and attached addendums YES NO

Notice to Bidders

Failure to affirm and/or submit the statements requested may cause a bid to be declared “Unresponsive” and rejected.

STANDARD SEALED BID FORM

FIRM NAME: __________________________________________________________

SIGNATURE OF AUTHORIZED PERSON:___________________________________

PRINT AUTHORIZED PERSON: ___________________________________________

TITLE OF AUTHORIZED PERSON: ________________________________________

ADDRESS: ___________________________________________________________

TELEPHONE: ________________________________________________________

FAX #:________________________________________________________________

E-MAIL __________________________________________________________

BIDDER’S FEDERAL EMPLOYERS’ IDENTIFICATION NO. ____________________

MARYLAND DEPARTMENT IDENTIFICATION______________________________

This is the number we will use to verify good-standing

BIDDER’S CONTRACTORS LICENSE AND PERMIT NUMBERS:

TYPE OF LICENSE: ___________________________ #:_________________

TYPE OF LICENSE: ___________________________ #:_________________

IF A BIDDERS AGENT:

BIDDERS AGENT (TYPED):___________________________________________

ADDRESS: ___________________________________________________________

Submitted by: __________________________________________________________, (Signature of the AUTHORIZED PERSON or BIDDERS AGENT)

*This line must be signed or the bid will be deemed incomplete* this _________________ day of ________________ 2025.

COMPREHENSIVE SIGNATURE PAGE 1 OF 2

THE BIDDER IS HEREBY NOTIFIED THAT THIS DOCUMENT SHALL BE SIGNED IN INK IN ORDER

FOR THE BID TO BE ACCEPTED. BY SIGNING, THE BIDDER CERTIFIES THAT HE/SHE WILL

COMPLY IN EVERY ASPECT WITH THESE SPECIFICATIONS.

FURTHER, I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT

THE CONTENTS OF THIS AFFIDAVIT (PARAGRAPHS A-J) ARE TRUE AND CORRECT TO THE BEST

OF MY KNOWLEDGE, INFORMATION, AND BELIEF.

This bid form shall be filled out legibly in ink or typed. The bid, if submitted by an individual, shall be signed by an individual; if submitted by a partnership, shall be signed by such member or members of the partnership as have authority to bind the partnership; if submitted by a corporation the same shall be signed by the President and attested by the Secretary or an Assistant Secretary. If not signed by the President as aforesaid, there must be attached a copy of that portion of the By-Laws, or a copy of a Board resolution, duly certified by the Secretary, showing the authority of the person so signing on behalf of the corporation.

In lieu thereof, the corporation may file such evidence with the County, duly certified by the Secretary, together with a list of the names of those officers having authority to execute documents on behalf of the corporation, duly certified by the Secretary, which listing shall remain in full force and effect until such time as the County is advised in writing to the contrary. In any case where a bid is signed by an Attorney in Fact the same must be accompanied by a copy of the appointing document, duly certified.

IF AN INDIVIDUAL:

NAME:

Street and/or P.O. Box

City State Zip Code Fed ID or SSN

(SEAL)

Signature Date

Print Signature

WITNESS:

Signature

COMPREHENSIVE SIGNATURE PAGE 2 OF 2

IF A PARTNERSHIP:

NAME OF PARTNERSHIP:

BY: (SEAL)

TITLE: WITNESS:

Signature

IF A CORPORATION:

NAME OF CORPORATION:

STATE OF INCORPORATION:

BY: (SEAL)

TITLE: WITNESS:

Secretary’s Signature

NOTICE

All bidders shall complete and submit with their bid the Bid/Proposal Affidavit below.

A. AUTHORITY

I HEREBY AFFIRM THAT:

I, ___________________________ , am the ________________________ and the duly (Name of Bidder) (Title) authorized representative of the firm of ______________________________________________________ whose address is __________________________________________________________, and that I possess the legal authority to make this affidavit on behalf of myself and the firm for which I am acting.

B. AFFIRMATION REGARDING BRIBERY CONVICTIONS

I FURTHER AFFIRM THAT:

Neither I, nor to the best of my knowledge, information, and belief, the above business (as is defined in Section 16-101(b) of the State Finance and Procurement Article of the Annotated Code of Maryland), or any of its officers, directors, partners, controlling stockholders, or any of its employees directly involved in the business’s contracting activities, including obtaining or performing contracts with public bodies, has been convicted of, or has had probation before judgment imposed pursuant to Criminal Procedure Article, §6-220, Annotated Code of Maryland, or has pleaded nolo contendere to a charge of, bribery, attempted bribery, or conspiracy to bribe in violation of Maryland law, or of the law of any other state or federal law, except as follows (indicate the reasons why the affirmation cannot be given and list any conviction, plea, or imposition of probation before judgment with the date, court, official or administrative body, the sentence or disposition, the name(s) of person(s) involved, and their current positions and responsibilities with the business):

(Conduct prior to July 1, 1977, is not required to be reported).

C. AFFIRMATION REGARDING OTHER CONVICTIONS

Neither I, nor to the best of my knowledge, information, and belief, the above business, or any of its officers, directors, partners, controlling stockholders, or any of its employees directly involved in the business's contracting activities including obtaining or performing contracts with public bodies, has:

(1) Been convicted under state or federal statute of:

(a) a criminal offense incident to obtaining, attempting to obtain, or performing a public or private contract; or

(b) fraud, embezzlement, theft, forgery, falsification or destruction of records, or receiving stolen property;

(2) Been convicted of any criminal violation of a state or federal antitrust statute;

(3) Been convicted under the provisions of Title 18 of the United States Code for violation of the Racketeer Influenced and Corrupt Organization Act, 18 U.S.C. §1961, et seq., or the Mail Fraud Act, 18 U.S.C. §1341, et seq., for acts in connection with the submission of bids or proposals for a public or private contract;

(4) Been convicted of a violation of the State Minority Business Enterprise Law, Section 14-308 of the State Finance and Procurement Article of the Annotated Code of Maryland;

(5) Been convicted of a violation of the Section 11-205.1 of the State Finance and Procurement Article of the Annotated Code of Maryland;

(6) Been convicted of conspiracy to commit any act or omission that would constitute grounds for conviction or liability under any law or statute described in subsection (1) through (5) above;

(7) Been found civilly liable under a state or federal antitrust statute for acts or omissions in connection with the submission of bids or proposals for a public or private contract;

(8) Been found in a final adjudicated decision to have violated the Commercial Nondiscrimination Policy under Title 19 of the State Finance and Procurement Article of the Annotated Code of Maryland with regard to a public or private contract; or

(9) Been convicted of a violation of one or more of the following provisions of the Internal Revenue Code:

(a) §7201, Attempt to Evade or Defeat Tax;

(b) §7203, Willful Failure to File Return, Supply Information, or Pay Tax,

(c) §7205, Fraudulent Withholding Exemption Certificate or Failure to Supply Information,

(d) §7206, Fraud and False Statements, or

(e) §7207 Fraudulent Returns, Statements, or Other Documents;

(10) Been convicted of a violation of 18 U.S.C. §286 Conspiracy to Defraud the Government with Respect to Claims, 18 U.S.C. §287, False, Fictitious, or Fraudulent Claims, or 18 U.S.C. §371, Conspiracy to Defraud the United States;

(11) Been convicted of a violation of the Tax-General Article, Title 13, Subtitle 7 or Subtitle 10, Annotated Code of Maryland;

(12) Been found to have willfully or knowingly violated State Prevailing Wage Laws as provided in the State Finance and Procurement Article, Title 17, Subtitle 2, Annotated Code of Maryland, if:

(a) A court:

(i) Made the finding; and

(ii) Decision became final; or

(b) The finding was:

(i) Made in a contested case under the Maryland Administrative Procedure Act; and

(ii) Not overturned on judicial review;

(13) Been found to have willfully or knowingly violated State Living Wage Laws as provided in the State Finance and Procurement Article, Title 18, Annotated Code of Maryland, if:

(a) A court:

(i) Made the finding; and

(ii) Decision became final; or

(b) The finding was:

(i) Made in a contested case under the Maryland Administrative Procedure Act; and

(ii) Not overturned on judicial review;

(14) Been found to have willfully or knowingly violated the Labor and Employment Article, Title 3, Subtitles 3, 4, or 5, or Title 5, Annotated Code of Maryland, if:

(a) A court:

(i) Made the finding; and

(ii) Decision became final; or

(b) The finding was:

(i) Made in a contested case under the Maryland Administrative Procedure Act; and

(ii) Not overturned on judicial review; or

(15) Admitted in writing or under oath, during the course of an official investigation or other proceedings, acts or omissions that would constitute grounds for conviction or liability under any law or statute described in §§B and C and subsections D(1) — (14) above, except as follows (indicate reasons why the affirmations cannot be given, and list any conviction, plea, or imposition of probation before judgment with the date, court, official or administrative body, the sentence or disposition, the name(s) of the person(s) involved and their current positions and responsibilities with the business, and the status of any debarment):

D. AFFIRMATION REGARDING DEBARMENT

Neither I, nor to the best of my knowledge, information, and belief, the above business, or any of its officers, directors, partners, controlling stockholders, or any of its employees directly involved in the business’s contracting activities, including obtaining or performing contracts with public bodies, has ever been suspended or debarred (including being issued a limited denial of participation) by any public entity, except as follows (list each debarment or suspension providing the dates of the suspension or debarment, the name of the public entity and the status of the proceedings, the name(s) of the person(s) involved and their current positions and responsibilities with the business, the grounds of the debarment or suspension, and the details of each person's involvement in any activity that formed the grounds of the debarment or suspension):

E. AFFIRMATION REGARDING DEBARMENT OF RELATED ENTITIES

(1) The business was not established and it does not operate in a manner designed to evade the application of or defeat the purpose of debarment pursuant to Sections 16-101, et seq., of the State Finance and Procurement Article of the Annotated Code of Maryland; and

(2) The business is not a successor, assignee, subsidiary, or affiliate of a suspended or debarred business, except as follows (you must indicate the reasons why the affirmations cannot be given without qualification):

F. SUB-CONTRACT AFFIRMATION

Neither I, nor to the best of my knowledge, information, and belief, the above business, has knowingly entered into a contract with a public body under which a person debarred or suspended under Title 16 of the State Finance and Procurement Article of the Annotated Code of Maryland will provide, directly or indirectly, supplies, services, architectural services, construction related services, leases of real property, or construction.

G. AFFIRMATION REGARDING COLLUSION

Neither I, nor to the best of my knowledge, information, and belief, the above business has:

(1) Agreed, conspired, connived, or colluded to produce a deceptive show of competition in the compilation of the accompanying bid or offer that is being submitted;

(2) In any manner, directly or indirectly, entered into any agreement of any kind to fix the bid price or price proposal of the bidder or offeror or of any competitor, or otherwise taken any action in restraint of free competitive bidding in connection with the contract for which the accompanying bid or offer is submitted.

H. CERTIFICATION OF TAX PAYMENT

Except as validly contested, the business has paid, or has arranged for payment of, all taxes due the State of Maryland and has filed all required returns and reports with the Comptroller of the Treasury, the State Department of Assessments and Taxation, and the Department of Labor, Licensing, and Regulation, as applicable, and will have paid all withholding taxes due the State of Maryland prior to final settlement.

I. CONTINGENT FEES

The business has not employed or retained any person, partnership, corporation, or other entity, other than a bona fide employee, bona fide agent, bona fide salesperson, or commercial selling agency working for the business, to solicit or secure the Contract, and that the business has not paid or agreed to pay any person, partnership, corporation, or other entity, other than a bona fide employee, bona fide agent, bona fide salesperson, or commercial selling agency, any fee or any other consideration contingent on the making of the Contract.

J. ACKNOWLEDGEMENT

I ACKNOWLEDGE THAT this Affidavit is to be furnished to the County Procurement Officer and may be distributed to units of: (1) the State of Maryland; (2) counties or other subdivisions of the State of Maryland;

(3) other states; and (4) the federal government. I further acknowledge that this Affidavit is subject to applicable laws of the United States and the State of Maryland, both criminal and civil and that nothing in this Affidavit or any contract resulting from the submission of this bid or proposal shall be construed to supersede, amend, modify or waive, on behalf of Caroline County, the State of Maryland, or any unit of the State of Maryland having jurisdiction, the exercise of any statutory right or remedy conferred by the Constitution and the laws of Maryland with respect to any misrepresentation made or any violation of the obligations, terms and covenants undertaken by the above business with respect to (1) this Affidavit, (2) the contract, and (3) other Affidavits comprising part of the contract.

I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE

CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE,

INFORMATION, AND BELIEF.

By: ______________________________________ Date:____________________ (Signature of Authorized Representative and Affiant)

(Print name of Authorized Representative and Affiant)