Resolution of the City of Jersey City, N.J.

NON COLLUSION AFFIDAVITSTATE OF NEW JERSEYCITY OF JERSEY CITY ss:I certify that I am NinaK. Vellayan. Executive Vice Presidentof the firm of Official Payments Corp.the Respondent making the proposal for the above named project, and that I executed the saidproposal withfull authority so to do; that said Respondent has not, directly or indirectly enteredinto any agreement, paiticipated in any collusion, or otherwise taken any action inrestraint offree, competitive bidding in connection with the above named project; and that all statementscontained in said proposal and in this affidavit are true and correct, and made with fullknowledge that the City of Jersey City relies upon the truth of the statements contained in saidproposal and in the statements contained in this affidavit in awarding the contract for the saidproject.I further warrant that no person or selling agency has been employed to solicit or ~cure suchcontract upon an agreement or understanding for a commission, percentage, brokerage orcontingent fee, except bona fide employees or bona fide'agencies maintained by (N.J.S.A.52: 34-25)'(Signature of Respondent)established commercial or sellingSUBSCRffED AND SWORN TOBEFORE ME THIS DAY , ",).-i_J... / ."_ ie.(L'Ii_~/'-, l ((TYPE OR PRINT NAME OF AFFIANT UNDER SIGNATURE)OF20 /"-'/NOTARY PUBLIC OF i-/, IS:'.'A-1 c?_-MY COMMISSION EXPIRES:"20 ;' eX(NOTE: THIS FORM MUST BECOMPLETED, NOTARIZED AND RETURNEDWITH THIS PROPOSAL)..:~ò J';~~ ! zj", j.j',~; .",ld.:. \~'r', "\\\\\\\\\1111~i1111111,,1//1/,:S\~\\' ETHc J',....,,"..$" s .,.........~..~...... wi=..... ~ ':$" 0 ..' o~ '-/ ". "'i ~" ;:.' , ')0'. "-¥ !f.. ~~ Exprres -s, -. ~§ ::: ü iou ." : 'Õ ::~ N f 0 06-30.12 0: ~ ê~ (f '. 7';06230 .: ìJ I\. ......- "'(~GIN\I'""'" /~/ va ~ ..,....% 11 ................. 0 ...;....';"" ì.AY pù'Õ ,\,\\'Illiiill¡I/II!/II!I\I\\\\\\\\\'-, /, /. _./-J ~..)