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<strong>Loudoun</strong> <strong>Water</strong><br />

Request for Qualifications<br />

<strong>RFQ</strong># 2013-057-220A<br />

PART H.<br />

SIGNATURE PAGE<br />

The undersigned hereby certifies under oath that he or she is duly authorized to submit<br />

this Statement of Qualification on behalf of the Applicant and that the information set<br />

forth herein, including any information submitted as an attachment, is true, correct, and<br />

complete in all respects.<br />

_____________________________________<br />

Name of Applicant<br />

_____________________________________<br />

Signature of Authorized Representative<br />

_____________________________________<br />

Name of Representative<br />

_____________________________________<br />

Title<br />

_____________________________________<br />

Date<br />

[Notary Acknowledgements on Following Pages]<br />

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