Pricing Proposal Form (Page 3 of 7) in pdf

Pricing Proposal Form Page 3

Affidavit

State of New York )

ss:

County of Suffolk

)

__________________________________, being duly sworn, deposes and states as follows:

I make this affidavit in support of my proposal to the Board of Elections for the County

of Suffolk in response to an Invitation to Bid issued by the Board of Elections for the

Transportation of Voting Machines.

I am an officer of ___________________________________ (hereinafter referred to

as the Corporation) and in such capacity I have knowledge of all employees and

consultants receiving compensation from the Corporation.

Based on my personal knowledge and in my capacity as an Officer of the Corporation, I swear, under

penalties of perjury, that no one receiving compensation, of any kind, from the Corporation has been

in service of the Board of Elections for the County of Suffolk within the last two years of the date of

this affidavit.

_______________________________________

Signature

Sworn to before me this

day of

, 2013

_____________________________

Notary Public

Pricing Proposal Form Page 3