ACKNOWLEDGMENT, CONSENT AND DISCLOSURE FORMDecember 1st, 2014
FiledDecember 1st, 2014Reference is hereby made to that certain Agreement] (the “Agreement”), proposed to be entered into on or about , by and between , a (the “Contractor”), and the New Mexico State Investment Council, an instrumentality of the State of New Mexico (“NMSIC”).[this space provided to explain relationships between/among business entities—delete brackets and this note if don’t need] In order to induce NMSIC to consider entering into the Agreement, Contractor desires to submit this Acknowledgement, Consent and Disclosure Form, including Schedule A hereto (this “Form”). Specifically, by signing this Form, Contractor hereby expressly represents and covenants as follows: