Common use of GEORGIA INSTITUTE OF TECHNOLOGY Clause in Contracts

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of (month), 20 (year) in (city), (state) Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF I do solemnly swear on my oath that as to the Contract dated , 20 , between and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of , 20 . Signature Title Firm COUNTY OF STATE OF Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 . STATUTORY AFFIDAVIT COUNTY OF STATE OF FROM: Contractor TO: Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located at

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) in (city), (state) Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF _ I do solemnly swear on my oath that as to the Contract dated , 20 , between and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of , 20 . Signature Title Firm COUNTY OF STATE OF _ Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 20_ . STATUTORY AFFIDAVIT COUNTY OF STATE OF _ FROM: Contractor TO: _ Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located at

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) in (city), (state) Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF _ I do solemnly swear on my oath that as to the Contract dated , 20 , between and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of _, 20 . Signature Title Firm COUNTY OF STATE OF _ Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 20_ . STATUTORY AFFIDAVIT COUNTY OF STATE OF _ FROM: Contractor TO: _ Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located atat _

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) in (city), (state) Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF _ I do solemnly swear on my oath that as to the Contract dated , 20 , between and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of , 20 . Signature Title Firm COUNTY OF STATE OF _ Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 20_ . STATUTORY AFFIDAVIT COUNTY OF STATE OF _ FROM: Contractor TO: _ Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located atat _

GEORGIA INSTITUTE OF TECHNOLOGY. Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on (day), of _(month), 20 20_ _(year) in (city), (state) Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 NOTARY PUBLIC My Commission Expires: NON-INFLUENCE AFFIDAVIT COUNTY OF STATE OF _ I do solemnly swear on my oath that as to the Contract dated , 20 , between and the Owner, I have no knowledge of the exertion of any influence or the attempted exertion of any influence on the firm on behalf of which this affidavit is made in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by any employee, officer, or agent of the Owner, or any person connected with the State Government of Georgia in any way whatsoever. This day of , 20 . Signature Title Firm COUNTY OF STATE OF _ Personally before me, the undersigned authority, appeared (NAME OF PERSON SIGNING THE AFFIDAVIT) who is known to me to be an official of the firm of , (NAME OF CONTRACTOR) and who, after being duly sworn, stated on his oath that he had read the above statement and that the same is true and correct. Notary Public My Commission expires This day of , 20 20_ . STATUTORY AFFIDAVIT COUNTY OF STATE OF _ _ FROM: Contractor TO: _ Owner Re: Contract entered into the day of , 20 , between the above-mentioned parties for the construction of Project No. located at