Common use of BACKGROUND AND EXPERIENCE CERTIFICATION FORM Clause in Contracts

BACKGROUND AND EXPERIENCE CERTIFICATION FORM. The undersigned, having read all the specifications contained herein certifies the following: I, am the of (Authorized Representative’s Name) (Title) hereinafter “Vendor,” and am legally authorized to (Vendor’s Company Name) represent and bind the Vendor and have personal knowledge of the information provided below. I hereby certify that the following information is true and correct to the best of my knowledge: Provide brief description of company: Company incorporation date: Provide brief background of company: How many years of IV&V experience does the company have? (Check one) Up to 3 years IV&V experience  10 plus years IV&V experience  AUTHORIZED SIGNATURE COMPANY NAME ATTACHMENT C RESPONSIBLE VENDOR REVIEW FORM Respondent Name: Respondent Address: Vendors are required to answer the questions set forth below, and for each “YES” answer provide a detailed, written explanation (in Section One of its Response) relevant to each “YES” answer and attach copies of documents relevant to written explanation(s) provided. The undersigned, as an authorized representative of the above-named Respondent, having direct knowledge of the legal affairs and contractual relationships and responsibilities of Respondent, hereby attests to the accuracy of the following information:

BACKGROUND AND EXPERIENCE CERTIFICATION FORM. The undersigned, having read all the specifications contained herein certifies the following: I, am the of (Authorized Representative’s Name) (Title) hereinafter “Vendor,” and am legally authorized to (Vendor’s Company Name) represent and bind the Vendor and have personal knowledge of the information provided below. I hereby certify that the following information is true and correct to the best of my knowledge: Provide brief description of company: Company incorporation date: Provide brief background of company: How many years of IV&V experience does the company have? (Check one) Up to 3 years IV&V experience  ❒ 7 to 10 years IV&V experience ❒ 10 plus years IV&V experience  ❒ AUTHORIZED SIGNATURE COMPANY NAME ATTACHMENT C RESPONSIBLE VENDOR REVIEW FORM Respondent Name: Respondent Address: Vendors are required to answer the questions set forth below, and for each “YES” answer provide a detailed, written explanation (in Section One of its Response) relevant to each “YES” answer and attach copies of documents relevant to written explanation(s) provided. The undersigned, as an authorized representative of the above-named Respondent, having direct knowledge of the legal affairs and contractual relationships and responsibilities of Respondent, hereby attests to the accuracy of the following information: