Signature__86_.pdf

State of Ohio, Department of Transportation (ODOT)

Office of Contract Sales, Purchasing Services

SIGNATURE PAGE

Procurement # 801L-26

Commodity/Service: Liquid Asphalt

This Signature Page, once fully executed, serves as acknowledgement to the Department that the Bidder understands and will comply with all terms, conditions, and requirements in submitting a response for the above-referenced procurement.

Furthermore, the execution of this Signature Page shall serve as acknowledgment that the Bidder is entering into a Contract with the State of Ohio, Department of Transportation and has been selected for award of the above-referenced procurement and understands it shall be bound by all terms and conditions included in this procurement.

The person signing and executing this Signature Page below acknowledges that he/she is signing on behalf of their Company in a representative capacity and hereby warrants that he/she has been duly authorized by his/her Company to submit this formal response and is authorized to execute Contracts on such Company’s behalf.

(Please execute below)

Company (Bidder) Name: ________________________________________________________

Signature: _____________________________________________________________

Print Name of Officer: ___________________________________________________________

Title of Signing Officer: __________________________________________________________

Date: _________________________________________

FOR USE BY THE OHIO DEPARTMENT OF TRANSPORTATION ONLY:

Pursuant to Section 33 of the Instructions, Terms and Conditions for Bidding, a signature below by the

Director of ODOT shall serve as the Department’s formal acceptance of the bidder’s offer and will effectively form ODOT Contract between the State of Ohio, Department of Transportation and the above successful bidder (company):

Pamela Boratyn as signed by Nathan Fling

Pamela Boratyn

Director

State of Ohio, Department of Transportation