/s/ Xxxxxx X Xxxxx ------------------- ..................
XX XXXXXXX XXXXXXX xxx undersigned, being the sole trustee of the Trust, has executed this Certificate of Trust as of the date first above written. Wilmington Trust Company, not in its individual capacity but solely as owner trustee under a Trust Agreement dated as of November 3, 2003 By: ______________________________________ Name: Title: EXHIBIT C [FORM OF RULE 144A INVESTMENT REPRESENTATION] Description of Rule 144A Securities, including numbers: -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- The undersigned seller, as registered holder (the "Seller"), intends to transfer the Rule 144A Securities described above to the undersigned buyer (the "Buyer").
Xxxxxx Xxxxxx The term “
Xxxxxxx Xxxxx Purchase Order and Sales Contact Email Please enter a valid email address that will definitely reach the Purchase Order and Sales Contact. 2 x.xxxxx@xxxxxxxxxxxxxxxxxxx.xxx Purchase Order and Sales Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 2 3 8168426066 Company Website Company Website (Format - xxx.xxxxxxx.xxx) 2 4 xxxxxxxxxxxxxxxxxxx.xxx Entity D/B/A's and Assumed Names You must confirm that you are responding to this solicitation under your legal entity name. Go now to your Supplier Profile in this eBid System and confirm that your profile reflects your "Legal Name" as it is listed on your W9. In this question, please identify all of your entity's assumed names and D/B/A's. Please note that you will be identified publicly by the Legal Name under which you respond to this solicitation unless you organize otherwise with TIPS after award. 5 XxXxxxxxx and Associates Corp. Primary Address Primary Address 2 6 0000 Xxxx Xxxxxx Primary Address City Primary Address City 2 North Kansas City Primary Address State Primary Address State (2 Digit Abbreviation) 2 8 Missouri Primary Address Zip Primary Address Zip 9 64116 Search Words Identifying Vendor Please list all search words and phrases to be included in the TIPS database related to your entity. Do not list words which are not associated with the bid category/scope (See bid title for general scope). This will help users find you through the TIPS website search function. You may include product names, manufacturers, specialized services, and other words associated with the scope of this solicitation. asphalt, concrete, sealcoat, crack fill, tennis, running track, pickleball, pavement maintenance, Certification of Vendor Residency (Required by the State of Texas) Does Vendor's parent company or majority owner:
Xxxxx Xxxxxxx Admin Fee Contact Email Admin Fee Contact Email 1 9 xxxxxxxxxx@xxxxxxxxxxxxxx.xxx Admin Fee Contact Phone Enter 10 digit phone number. (No dashes or extensions) Example: 8668398477 0 5016610621 Purchase Order Contact Name Purchase Order Contact Name. This person is responsible for receiving Purchase Orders from TIPS. Xxxxx Xxxxxxx Purchase Order Contact Email Purchase Order Contact Email 2 xxxxxxxxxx@xxxxxxxxxxxxxx.xxx Purchase Order Contact Phone Enter 10 digit phone number. (No dashes or extensions) Example: 8668398477 3 5016610621 Company Website Company Website (Format - xxx.xxxxxxx.xxx) 4 xxx.xxxxxxxxxxxxxx.xxx Entity D/B/A's and Assumed Names Please identify all of your entity's assumed names and D/B/A's. Please note that you will be identified publicly by the legal name under which you responded to this solicitation unless you organize otherwise with TIPS after award. Xxxxxxxx Energy Partners / Best HVAC Parts & Supply Primary Address Primary Address 0000 Xxxxxxxx Xxxxx, Xxxxx 0 Primary Address City Primary Address City 7 Little Rock Primary Address State Primary Address State (2 Digit Abbreviation) 2 8 AR Primary Address Zip Primary Address Zip 9 72204 Search Words: Please list search words to be posted in the TIPS database about your company that TIPS website users might search. Words may be product names, manufacturers, or other words associated with the category of award. YOU MAY NOT LIST NON-CATEGORY ITEMS. (Limit 500 words) (Format: product, paper, construction, manufacturer name, etc.) daikin, hvac, heating, air condition, ventilation, control, service, lennox, kmc, xxxxxxx, Do you want TIPS Members to be able to spend Federal grant funds with you if awarded? Is it your intent to be able to sell to our members regardless of the fund source, whether it be local, state or federal? Most of our members receive Federal Government grants or other funding and they make up a significant portion of their budgets. The Members need to know if your company is willing to sell to them when they spend federal budget funds on their purchase. There are attributes that follow that include provisions from the federal regulations in 2 CFR part 200, etc. Your answers will determine if your award will be designated as eligible for TIPS Members to utilize federal funds with your company. Do you want TIPS Members to be able to spend Federal funds, at the Member's discretion, with you? Yes Yes - No Certification of Residency - The vendor's ultimate parent company or majority owner:
Xxxxxx Xxxxxxx Purchase Order and Sales Contact Email Please enter a valid email address that will definitely reach the Purchase Order and Sales Contact. 2 2 xxxxxx@xxxxxxxxxxxxxxxxx.xxx Purchase Order and Sales Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 2 3 3152473177 Company Website Company Website (Format - xxx.xxxxxxx.xxx) 4 xxx.xxxxxxxxxxxxxxxxx.xxx Entity D/B/A's and Assumed Names You must confirm that you are responding to this solicitation under your legal entity name. Go now to your Supplier Profile in this eBid System and confirm that your profile reflects your "Legal Name" as it is listed on your W9. In this question, please identify all of your entity's assumed names and D/B/A's. Please note that you will be identified publicly by the Legal Name under which you respond to this solicitation unless you organize otherwise with TIPS after award. NGU Sports LIghting, LLC Primary Address Primary Address 6 0000 XXX Xxxx, Xxxxx 000 Primary Address City Primary Address City 2 7 Palm Beach Gardens Primary Address State Primary Address State (2 Digit Abbreviation) 2 8 FL Primary Address Zip Primary Address Zip 9 33410 Search Words Identifying Vendor Please list all search words and phrases to be included in the TIPS database related to your entity. Do not list words which are not associated with the bid category/scope (See bid title for general scope). This will help users find you through the TIPS website search function. You may include product names, manufacturers, specialized services, and other words associated with the scope of this solicitation. LED lighting, LED Sports Lighting, LED Indoor lighting, LED Field lighting, Sports lighting, Field lighting, Colored lighting, Convention Center Lighting Certification of Vendor Residency (Required by the State of Texas) Does Vendor's parent company or majority owner:
Xxxxx Xxxxxxxx Admin Fee Contact Email Admin Fee Contact Email 1 9 xxxxxxx@xx-xxxxxxxxxx.xxx Admin Fee Contact Phone Enter 10 digit phone number. (No dashes or extensions) Example: 8668398477 0 4098423737 Purchase Order Contact Name Purchase Order Contact Name. This person is responsible for receiving Purchase Orders from TIPS. Xxxxxx Xxxxxx Purchase Order Contact Email Purchase Order Contact Email 2 xxxxxxx@xx-xxxxxxxxxx.xxx Purchase Order Contact Phone Enter 10 digit phone number. (No dashes or extensions) Example: 8668398477 3 4098423737 Company Website Company Website (Format - xxx.xxxxxxx.xxx) 4 xxx.xxxxxxxxxxxxxxxxxx.xxx Entity D/B/A's and Assumed Names Please identify all of your entity's assumed names and D/B/A's. Please note that you will be identified publicly by the legal name under which you responded to this solicitation unless you organize otherwise with TIPS after award. 5 Industrial & Commercial Mechanical, LLC Primary Address Primary Address 2 6 0000 Xxxxxxxx Xxxxxx Primary Address City Primary Address City 7 Beaumont Primary Address State Primary Address State (2 Digit Abbreviation) 2 8 TX Primary Address Zip Primary Address Zip 9 77705 Search Words: Please list search words to be posted in the TIPS database about your company that TIPS website users might search. Words may be product names, manufacturers, or other words associated with the category of award. YOU MAY NOT LIST NON-CATEGORY ITEMS. (Limit 500 words) (Format: product, paper, construction, manufacturer name, etc.) 3 A/C, Air conditioning, heating, ductwork, sheet metal, refrigeration, cooler, freezer, ventilation, HVAC, HVAC/R Do you want TIPS Members to be able to spend Federal grant funds with you if awarded? Is it your intent to be able to sell to our members regardless of the fund source, whether it be local, state or federal? Most of our members receive Federal Government grants or other funding and they make up a significant portion of their budgets. The Members need to know if your company is willing to sell to them when they spend federal budget funds on their purchase. There are attributes that follow that include provisions from the federal regulations in 2 CFR part 200, etc. Your answers will determine if your award will be designated as eligible for TIPS Members to utilize federal funds with your company. Do you want TIPS Members to be able to spend Federal funds, at the Member's discretion, with you? Yes Yes - No Certification of Residency - The vendor's ultimate parent company or majority owner:
Xxxxxxxx-Xxxxx The Company is in compliance, in all material respects, with all applicable provisions of the Xxxxxxxx-Xxxxx Act of 2002 and the rules and regulations promulgated thereunder.
