Check one. I am a United States citizen or legal permanent resident. The Town must verify this statement by reviewing one of the following items: ▪ A valid Colorado driver's license or a Colorado identification card;
Check one o (1) This Note is being transferred to a “qualified institutional buyer” in compliance with Rule 144A under the Securities Act of 1933, as amended and certification in the form of Exhibit F to the Indenture is being furnished herewith.
Check one. ☐ Tenant is NOT allowed to have or keep any pets, even temporarily, on any part of the Premises. ☐ Tenant is allowed to have the following pets on the Premises: . The unauthorized presence of any pet may subject Subtenant to penalties, damages, deductions and termination of this Sublease. Properly trained service animals that provide assistance to individuals with disabilities will be permitted on the Premises with the prior written consent of the Tenant. Subtenant will be responsible for the costs of defleaing, deodorizing and/or shampooing all or any portion of the Premises if a pet has been on the Premises at any time during the Term (whether with or without written consent of the Tenant).
Check one. ☐ Smoking of any kind is strictly prohibited on any part of the Premises. This prohibition applies to Subtenant and any visitor, guest or other occupant on the Premises. ☐ Smoking is permitted on the Premises.
Check one. As the person authorized to sign this statement, I certify that this firm complies fully with above requirements. As the person authorized to sign this statement, this firm does not comply fully with the above requirements. Offeror's Signature Date Information Sheet
Check one. □ Reservations will be made by rooming list. The Department will forward the rooming list to the Hotel on or before (the “Cut-Off Date”). □ Reservations will be made by individual guests on or before (the “Cut-Off Date”).
Check one. ☐ (1) This Warrant Certificate is being transferred to a “qualified institutional buyer” in compliance with Rule 144A under the Securities Act of 1933, as amended and certification in the form of Exhibit C to the Warrant Agreement is being furnished herewith. or
Check one. I, , am a United States citizen or legal permanent resident. The City must verify this statement by reviewing one of the following items:
Check one. The section not marked shall not be a part of Agreement.]
Check one. [ ] The undersigned proposer has had no litigation and/or judgments entered against it by any local, state or federal entity and has had no litigation and/or judgments entered against such entities during the past ten (10) years. [ ] The undersigned proposer, BY ATTACHMENT TO THIS FORM, submits a summary and disposition of individual cases of litigation and/or judgments entered by or against any local, state or federal entity, by any state or federal court, during the past ten (10) years. COMPANY NAME AUTHORIZED SIGNATURE NAME (PRINT OR TYPE) TITLE Failure to check the appropriate blocks above may result in disqualification of your bid. Likewise, failure to provide documentation of a possible conflict of interest, or a summary of past litigation and/or judgments, may result in disqualification of your bid. E VERIFICATION CERTIFICATION Contract No. Y21-191-KB NAME OF CONTRACTOR: “Contractor”)
