Common use of AGENT AUTHORIZATION FORM Clause in Contracts

AGENT AUTHORIZATION FORM. I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires:

AGENT AUTHORIZATION FORM. I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB IFB/RFP NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . (Notary Seal) Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires:

AGENT AUTHORIZATION FORM. I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: The following certification and disclosure regarding payments to influence certain federal transactions are made per the provisions contained in 31 U.S.C 1352, the “Xxxx Anti-Lobbying Amendment.” The undersigned [Contractor] certifies, to the best of his or her knowledge, that: