Executive Recruitment Services

REQUEST FOR PROPOSALS (RFP)

Specification No. 26-11750-C

EXECUTIVE RECRUITMENT SERVICES

PROPOSALS WILL NOT BE OPENED AND READ PUBLICLY

Dear Proposer:

The City of Berkeley is soliciting written proposals from qualified firms or individuals for Executive Recruitment Services. As a Request for Proposal (RFP) this is not an invitation to bid and although price is very important, other factors will be taken into consideration.

The project scope, content of proposal, and vendor selection process are summarized in the RFP (attached). Proposals must be received no later than 2:00 pm, on Thursday, December 2, 2025. Proposals are to be sent via email with the “Specification No. #26-11750-C Executive Recruitment Services” clearly indicated in the subject line of the email. Please submit one (1) PDF of the technical Proposal with the filename saved as, “Proposal Vendor Name – 26-11750-C-Executive Recruitment Services”. Corresponding pricing proposal shall be submitted as a separate document with the filename saved as, “Pricing Vendor Name – 26-11750-C, Executive Recruitment Services”

Email Proposals to:

City of Berkeley

Finance Department/General Services Division

purchasing@berkeleyca.gov

Proposals will not be accepted after the date and time stated above. Incomplete proposal or proposals that do not conform to the requirements specified herein will not be considered. Issuance of the RFP does not obligate the City to award a contract, nor is the City liable for any costs incurred by the proposer in the preparation and submittal of proposals for the subject work. The City retains the right to award all or parts of this contract to several bidders, to not select any bidders, and/or to re-solicit proposals. The act of submitting a proposal is a declaration that the proposer has read the RFP and understands all the requirements and conditions.

For questions concerning the anticipated work, or scope of the project, please contact Monica Walker (Project Manager), via email at MWalker@berkeleyca.gov no later than November 14th, 2025. Answers to questions will not be provided by telephone or email. Answers to all questions or any addenda will be posted on the City of Berkeley’s site at Bid & Proposal Opportunities | City of Berkeley (berkeleyca.gov) . It is the vendor’s responsibility to check this site. For general questions concerning the submittal process, contact purchasing at 510-981-7320.

We look forward to receiving and reviewing your proposal.

Sincerely,

General Services Manager

I. BACKGROUND /SUMMARY/or INTRODUCTION

The City of Berkeley (“City”) is soliciting proposals from qualified contractors to provide services in the realms of Executive Recruitment Services. The City is seeking proposals from qualified recruitment/consulting firms with substantial and relevant experience in executive level recruiting interested in providing comprehensive recruitment for executive level positions aimed at identifying, attracting, and securing executives for key leadership roles across the city.

The City will award the service agreement based on considerations including costs, project approach, expertise and experience. The agreement’s duration will be for 3 years, with 2 additional one-year options at the City’s sole discretion to exercise.

The City is located in Alameda County, California. The City is composed of twelve departments: City Attorney, City Clerk, Finance, City Manager, Fire, Health, Housing and Community Services, Human Resources, Information Technology, Parks, Recreation and Waterfront, Planning and Development, Police, and Public Works. The City employs 1,427 full-time employees and 751 part-time employees.

II. SCOPE OF SERVICES

For each recruitment:

• Provide an initial quote to the City for the scope of services prior to beginning services.

• Facilitate kick-off meetings with key stakeholders - such as the Director of Human Resources, representatives from the stakeholder department, and the City Manager’s Office - to gather insights into the position’s background, responsibilities, expectations, and potential challenges.

• Develop advertising brochures including but not limited to, the position profile, ideal candidate, department, City information, demographics, budget, and organizational structure. and advertising brochure.

• Create a recruiting campaign plan for talent that may include national, regional, in-state, and local elements as determined during the initial meetings with the City.

• Advertise in industry websites, professional publications, job bulletin boards.

• Screen applications/resumes for minimum qualifications in relation to the job class specification and identified competencies.

• Screen applicants through face-to-face interactions, videoconference, or phone.

• Present a list of finalists (to be interviewed) to the key stakeholders including, but not limited to, the Director of Human Resources, Stakeholder Department, and the City Manager's Office.

• Assist with assembling assessment centers and interview panels for multiple interview levels (first-round, second-round/finalists).

• Conduct background pre-employment checks on final candidate.

• Additional tasks as needed to complete the recruitment, with additional work compensated as agreed upon in the consultant’s contract with the City.

III. SUBMISSION REQUIREMENTS

All proposals shall include the following information, organized as separate sections of the proposal. The proposal should be concise and to the point.

1. Contractor Identification:

Provide the name of the firm, the firm's principal place of business (see section VII, F. – Local Vendor Preference), the name and telephone number of the contact person and company tax identification number.

2. Client References: (3-5 References are usual)

Provide a minimum of 3 client references. References should be California cities or other large public sector entities. Provide the designated person's name, title, organization, address, telephone number, and the project(s) that were completed under that client’s direction.

3. Price Proposal:

The proposal shall include pricing for all services. Pricing shall be all inclusive unless indicated otherwise. Pricing proposals should be a separate document. The Proposal shall itemize all services, including hourly rates for all professional, technical and support personnel, and all other charges related to completion of the work shall be itemized. Evaluations of price proposals are subject to the local vendor business preference (see section VII.F.). Please include price proposals for different recruitment options, if available (i.e.. Partial recruitment: advertising and headhunting; partial recruitment: up to interviews; full search services).

4. Contract Terminations:

If your organization has had a contract terminated in the last five (5) years, describe such incident. Termination for default is defined as notice to stop performance due to the vendor’s non-performance or poor performance and the issue of performance was either (a) not litigated due to inaction on the part of the vendor, or (b) litigated and such litigation determined that the vendor was in default.

Submit full details of the terms for default including the other party’s name, address, and phone number. Present the vendor’s position on the matter. The City will evaluate the facts and may, at its sole discretion, reject the proposal on the grounds of the past experience.

If the firm has not experienced any such termination for default or early termination in the past five (5) years, so indicate.

5. (Other submission requirements are needed to evaluate proposals and determine if contractor is qualified to do project.)

IV. SELECTION CRITERIA

The following criteria will be considered, although not exclusively, in determining which firm is hired.

1. Project Approach 10%

2. Expertise & References 25%

3. Key Personnel 20%

4. Organizational Capacity 10%

5. Past Performance 10%

6. Costs* 25%

* Effective 1/1/2022. Local Vendor Preference. For the purpose of comparing pricing as part of this competitive RFP for goods up to $100,000 or non-professional services up to $250,000, 5% shall be deducted from the bid price proposal from any local Berkeley vendor.

A selection panel will be convened of staff to evaluate and score submittals.

V. PAYMENT

Invoices: Invoices must be fully itemized and provide sufficient information for approving payment and audit. Invoices must be accompanied by receipt for services in order for payment to be processed. Email invoices to hr_invoices@berkeleyca.gov , Attn: Monica Walker Project Manager; (List on invoice, Attn: Monica Walker/Project Manager) and reference the contract number.

City of Berkeley

Accounts Payable

P.O. Box 700

Berkeley, CA 94710-700

Email: hr_invoices@berkeleyca.gov

Phone: 510-981-7310

Payments: The City will make payment to the vendor within 30 days of receipt of a correct, approved and complete invoice.

VI. CITY REQUIREMENTS

(Do not modify any part of this section except: Living Wage would not apply if commodities were being purchased and Equal Benefits would not apply if the contract amount would be less than $25,000. If this is the case, do not delete the section just note next to it “Does Not Apply to this Request for Proposal”)

A. Non-Discrimination Requirements:

Ordinance No. 5876-N.S. codified in B.M.C. Chapter 13.26 states that for contracts worth more than $3,000 bids for supplies or bids or proposals for services shall include a completed Workforce Composition Form. Businesses with fewer than five employees are exempt from submitting this form. (See B.M.C. 13.26.030)

Under B.M.C. section 13.26.060, the City may require any bidder or vendor it believes may have discriminated to submit a Non-Discrimination Program. The Contract Compliance Officer will make this determination. This applies to all contracts and all consultants (contractors). Berkeley Municipal Code section 13.26.070 requires that all contracts with the City contain a non-discrimination clause, in which the contractor agrees not to discriminate and allows the City access to records necessary to monitor compliance. This section also applies to all contracts and all consultants.

Bidders must submit the attached Non-Discrimination Disclosure Form with their proposal.

B. Nuclear Free Berkeley Disclosure Form:

Berkeley Municipal Code section 12.90.070 prohibits the City from granting contracts to companies that knowingly engage in work for nuclear weapons. This contracting prohibition may be waived if the City Council determines that no reasonable alternative exists to doing business with a company that engages in nuclear weapons work. If your company engages in work for nuclear weapons, explain on the Disclosure Form the nature of such work. Bidders must submit the attached Nuclear Free Disclosure Form with their proposal.

C. Oppressive States:

The City of Berkeley prohibits granting of contracts to firms that knowingly provide personal services to specified Countries. This contracting prohibition may be waived if the City Council determines that no reasonable alternative exists to doing business with a company that is covered by City Council Resolution Nos. 59,853-N.S., 60,382-N.S., and 70,606-N.S. If your company or any subsidiary is covered, explain on the Disclosure Form the nature of such work.

Bidders must submit the attached Oppressive States Disclosure Form with their proposal.

D. Sanctuary City Contracting Ordinance:

Chapter 13.105 of the Berkeley Municipal Code prohibits the City from granting and or retaining contracts with any person or entity that provides Data Broker or Extreme Vetting services to the U.S. Immigration and Customs Enforcement Division of the United States Department of Homeland Security (“ICE”).

Bidders must submit the attached Sanctuary City Compliance Statement with their proposal.

E. Conflict of Interest:

In the sole judgment of the City, any and all proposals are subject to disqualification on the basis of a conflict of interest. The City may not contract with a vendor if the vendor or an employee, officer or director of the proposer's firm, or any immediate family member of the preceding, has served as an elected official, employee, board or commission member of the City who influences the making of the contract or has a direct or indirect interest in the contract.

Furthermore, the City may not contract with any vendor whose income, investment, or real property interest may be affected by the contract. The City, at its sole option, may disqualify any proposal on the basis of such a conflict of interest. Please identify any person associated with the firm that has a potential conflict of interest.

F. Berkeley Living Wage Ordinance:

Chapter 13.27 of the Berkeley Municipal Code requires that contractors offer all eligible employees with City mandated minimum compensation during the term of any contract that may be awarded by the City. If the Contractor is not currently subject to the Living Wage Ordinance, cumulative contracts with the City within a one-year period may subject Contractor to the requirements under B.M.C. Chapter 13.27. A certification of compliance with this ordinance will be required upon execution of a contract. The current Living Wage rate can be found here: Information for Vendors | City of Berkeley (berkeleyca.gov) . The Living Wage rate is adjusted automatically effective June 30th of each year commensurate with the corresponding increase in the Consumer Price Index published in April of each year. If the Living Wage rate is adjusted during the term of your agreement, you must pay the new adjusted rate to all eligible employees, regardless of what the rate was when the contract was executed.

G. Berkeley Equal Benefits Ordinance:

Chapter 13.29 of the Berkeley Municipal Code requires that contractors offer domestic partners the same access to benefits that are available to spouses. A certification of compliance with this ordinance will be required upon execution of a contract.

H. Statement of Economic Interest:

The City’s Conflict of Interest Code designates “consultants” as a category of persons who must complete Form 700, Statement of Economic Interest, at the beginning of the contract period and again at the termination of the contract. The selected contractor will be required to complete the Form 700 before work may begin.

VII. OTHER REQUIREMENTS

A. Insurance

The selected contractor will be required to maintain general liability insurance in the minimum amount of $2,000,000, automobile liability insurance in the minimum amount of $1,000,000 and a professional liability insurance policy in the amount of $2,000,000 to cover any claims arising out of the performance of the contract. The general liability and automobile insurance must name the City, its officers, agents, volunteers and employees as additional insured.

Insurance not Necessary: If the services are such that the risk of exposure to liability is very low, insurance may not be required. An example of such a service is an individual using his/her computer at home to lay out a newsletter for the City.

** This determination must be made by the Risk Manager in writing before the RFP is issued. **

Insurance Waiver: A situation in which insurance is not necessary is different from a case in which insurance may be waived. An insurance waiver is appropriate where insurance would usually be necessary but when, as a policy matter, the City is willing to take the risk of allowing an uninsured or under-insured individual or business to perform the work (usually when the risk of liability is low). An insurance waiver may be granted only by the Risk Manager in writing with the approval of the City Manager. If a potential bidder expresses an inability to meet the insurance requirement, he or she should be encouraged to contact the Project Manager & Risk Manager for assistance in obtaining insurance.)

B. Worker’s Compensation Insurance:

A selected contractor who employs any person shall maintain workers' compensation insurance in accordance with state requirements. Sole proprietors with no employees are not required to carry Worker’s Compensation Insurance.

C. Business License

Virtually every contractor that does business with the City must obtain a City business license as mandated by B.M.C. Ch. 9.04. The business license requirement applies whether or not the contractor has an office within the City limits. However, a "casual" or "isolated" business transaction (B.M.C. section 9.04.010) does not subject the contractor to the license tax. Warehousing businesses and charitable organizations are the only entities specifically exempted in the code from the license requirement (see B.M.C. sections, 9.04.295 and 9.04.300). Non-profit organizations are granted partial exemptions (see B.M.C. section 9.04.305). Persons who, by reason of physical infirmity, unavoidable misfortune, or unavoidable poverty, may be granted an exemption of one annual free license at the discretion of the Director of Finance. (See B.M.C. sections 9.04.290).

Vendor must apply for a City business license and show proof of application to Purchasing Manager within seven days of being selected as intended contractor.

The Customer Service Division of the Finance Department located at 1947 Center Street, Berkeley, CA 94704, issues business licenses. Contractors should contact this division for questions and/or information on obtaining a City business license, in person, or by calling 510-981-7200.

D. Recycled Paper

Any printed reports for the City required during the performance of the work shall be on 100% recycled paper and shall be printed on both sides of the page whenever practical.

E. State Prevailing Wage:

Certain labor categories under this project may be subject to prevailing wages as identified in the State of California Labor Code commencing in Section 1770 et seq. These labor categories, when employed for any “work performed during the design and preconstruction phases of construction including, but not limited to, inspection and land surveying work,” constitute a “Public Work” within the definition of Section 1720(a)(1) of the California Labor Code requiring payment of prevailing wages.

Wage information is available through the California Division of Industrial Relations web site at:

http://www.dir.ca.gov/OPRL/statistics_and_databases.html

F. Local Vendor Preference

City of Berkeley applies a local vendor preference for comparing pricing submittals in RFP responses (City Council Resolution No. 69,890-N.S.)

A local business is defined as “a business firm with fixed offices or distribution points located within the City of Berkeley boundaries and listed in the Permits and License Tax paid file, with a Berkeley business street address.”

VIII. SCHEDULE (Dates are subject to change)

◊ Issue RFP to Potential Bidders: November 6, 2025

◊ Potential/Actual issue date November 6, 2025

◊ Questions Due November 14, 2025

◊ Proposals Due from Potential Bidders December 2, 2025

◊ Complete Selection Process December 19, 2025

◊ Council Approval of Contract (over $50k) January 27, 2026

◊ Award of Contract January 28, 2025

◊ Sign and Process Contract February 28, 2025

◊ Notice to Proceed January 28, 2025

Thank you for your interest in working with the City of Berkeley for this service. We look forward to receiving your proposal.

Attachments:

• Check List of Required items for Submittal Attachment A

• Non-Discrimination/Workforce Composition Form Attachment B

• Nuclear Free Disclosure Form Attachment C

• Oppressive States Form Attachment D

• Sanctuary City Compliance Statement Attachment E

• Living Wage Form Attachment F

• Equal Benefits Certification of Compliance Attachment G

• Right to Audit Form Attachment H

• Insurance Endorsement Attachment I

ATTACHMENT A

CHECKLIST

◊ Proposal describing service (one (1) PDF of proposal)

◊ Contractor Identification and Company Information

◊ Client References

◊ Costs proposal by task, type of service & personnel (as a separate document from the proposal)

◊ The following forms, completed and signed in blue ink (attached):

o Non-Discrimination/Workforce Composition Form Attachment B

o Nuclear Free Disclosure Form Attachment C

o Oppressive States Form Attachment D

o Sanctuary City Compliance Statement Attachment E

o Living Wage Form (may be optional) Attachment F

o Equal Benefits Certification (EBO-1) (may be optional) Attachment G

ADDITIONAL SUBMITTALS REQUIRED FROM SELECTED VENDOR AFTER COUNCIL APPROVAL TO AWARD CONTRACT.

◊ Provide original-signed in blue ink Evidence of Insurance

o Auto

o Liability

o Worker’s Compensation

◊ Right to Audit Form Attachment H

◊ Commercial General & Automobile Liability Endorsement Form Attachment I

◊ Berkeley Business License (Current Year Certificate)

For informational purposes only: Sample of Personal Services Contract can be found on the City’s website on the current bid and proposal page at the top of the page.

NON-DISCRIMINATION/WORKFORCE COMPOSITION FORM FOR NON-CONSTRUCTION CONTRACTS

To assist the City of Berkeley in implementing its Non-Discrimination policy, it is requested that you furnish information regarding your personnel as requested below and return it to the City Department handling your contract: Organization: _____________________________________________________________________________________ Address: _______________________________________________________________ Business Lic. #: ___________

Occupational Category: __________________________ (See reverse side for explanation of terms)

Total Employees

White Employees

Black Employees

Asian Employees

Hispanic Employees

Other Employees

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Official/Administrators

Professionals

Technicians

Protective Service Workers

Para-Professionals

Office/Clerical

Skilled Craft Workers

Service/Maintenance

Other (specify)

Totals:

Is your business MBE/WBE/DBE certified? Yes: _____ No: _____ If yes, by what agency? _______________________

If yes, please specify: Male: _____ Female: _____ Indicate ethnic identifications: ___________________________

Do you have a Non-Discrimination policy? Yes: _____ No: _____

Signed: ________________________________________________________________ Date: __________________

Verified by: _____________________________________________________________ Date: __________________

City of Berkeley Contract Compliance Officer

Executive Recruitment Services No. 26-11750-C Attachment B (page 1)

Occupational Categories

Officials and Administrators - Occupations in which employees set broad policies, exercise overall responsibility for execution of these policies, or provide specialized consultation on a regional, district or area basis. Includes: department heads, bureau chiefs, division chiefs, directors, deputy superintendents, unit supervisors and kindred workers.

Professionals - Occupations that require specialized and theoretical knowledge that is usually acquired through college training or through work experience and other training that provides comparable knowledge. Includes: personnel and labor relations workers, social workers, doctors, psychologists, registered nurses, economists, dietitians, lawyers, systems analysts, accountants, engineers, employment and vocational rehabilitation counselors, teachers or instructors, and kindred workers.

Technicians - Occupations that require a combination of basic scientific or technical knowledge and manual skills that can be obtained through specialized post-secondary school education or through equivalent on-the-job training. Includes: computer programmers and operators, technical illustrators, highway technicians, technicians (medical, dental, electronic, physical sciences) and kindred workers.

Protective Service Workers - Occupations in which workers are entrusted with public safety, security and protection from destructive forces. Includes: police officers, fire fighters, guards, sheriffs, bailiffs, correctional officers, detectives, marshals, harbor patrol officers, and kindred workers.

Para-Professionals - Occupations in which workers perform some of the duties of a professional or technician in a supportive role, which usually requires less formal training and/or experience normally required for professional or technical status. Such positions may fall within an identified pattern of staff development and promotion under the “New Transporters" concept. Includes: library assistants, research assistants, medical aides, child support workers, police auxiliary, welfare service aides, recreation assistants, homemaker aides, home health aides, and kindred workers.

Office and Clerical - Occupations in which workers are responsible for internal and external communication, recording and retrieval of data and/or information and other paperwork required in an office. Includes: bookkeepers, messengers, office machine operators, clerk-typists, stenographers, court transcribers, hearings reporters, statistical clerks, dispatchers, license distributors, payroll clerks, and kindred workers.

Skilled Craft Workers - Occupations in which workers perform jobs which require special manual skill and a thorough and comprehensive knowledge of the processes involved in the work which is acquired through on-the-job training and experience or through apprenticeship or other formal training programs. Includes: mechanics and repairpersons, electricians, heavy equipment operators, stationary engineers, skilled machining occupations, carpenters, compositors and typesetters, and kindred workers.

Service/Maintenance - Occupations in which workers perform duties which result in or contribute to the comfort, convenience, hygiene or safety of the general public or which contribute to the upkeep and care of buildings, facilities or grounds of public property. Workers in this group may operate machinery. Includes: chauffeurs, laundry and dry-cleaning operatives, truck drivers, bus drivers, garage laborers, custodial personnel, gardeners and groundskeepers, refuse collectors, and construction laborers.

Executive Recruitment Services No. 26-11750-C Attachment B (page 2)
CITY OF BERKELEY

Nuclear Free Zone Disclosure Form

I (we) certify that:

1. I am (we are) fully cognizant of any and all contracts held, products made or otherwise handled by this business entity, and of any such that are anticipated to be entered into, produced or handled for the duration of its contract(s) with the City of Berkeley. (To this end, more than one individual may sign this disclosure form, if a description of which type of contracts each individual is cognizant is attached.)

2. I (we) understand that Section 12.90.070 of the Nuclear Free Berkeley Act (Berkeley Municipal Code Ch. 12.90; Ordinance No. 5784-N.S.) prohibits the City of Berkeley from contracting with any person or business that knowingly engages in work for nuclear weapons.

3. I (we) understand the meaning of the following terms as set forth in Berkeley Municipal Code Section 12.90.130:

"Work for nuclear weapons" is any work the purpose of which is the development, testing, production, maintenance or storage of nuclear weapons or the components of nuclear weapons; or any secret or classified research or evaluation of nuclear weapons; or any operation, management or administration of such work.

"Nuclear weapon" is any device, the intended explosion of which results from the energy released by reactions involving atomic nuclei, either fission or fusion or both. This definition of nuclear weapons includes the means of transporting, guiding, propelling or triggering the weapon if and only if such means is destroyed or rendered useless in the normal propelling, triggering, or detonation of the weapon.

"Component of a nuclear weapon" is any device, radioactive or non-radioactive, the primary intended function of which is to contribute to the operation of a nuclear weapon (or be a part of a nuclear weapon).

4. Neither this business entity nor its parent nor any of its subsidiaries engages in work for nuclear weapons or anticipates entering into such work for the duration of its contract(s) with the City of Berkeley.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Printed Name: ___________________________________ Title: ____________________________________

Signature: _______________________________________Date: ____________________________________

Business Entity: ___________________________________________________________________________

Executive Recruitment Services No. 26-11750-C Attachment C

CITY OF BERKELEY

Oppressive States Compliance Statement

The undersigned, an authorized agent of_________________________________________________ (hereafter "Vendor"), has had an opportunity to review the requirements of Berkeley City Council Resolution Nos. 59,853-N.S., 60,382-N.S., and 70,606-N.S., (hereafter "Resolutions"). Vendor understands and agrees that the City may choose with whom it will maintain business relations and may refrain from contracting with those Business Entities which maintain business relationships with morally repugnant regimes. Vendor understands the meaning of the following terms used in the Resolution:

"Business Entity" means "any individual, firm, partnership, corporation, association or any other commercial organization, including parent-entities and wholly owned subsidiaries" (to the extent that their operations are related to the purpose of the contract with the City).

"Oppressive State" means: Tibet Autonomous Region and the Provinces of Ado, Kham and U-Tsang; and Burma (Myanmar)

“Personal Services” means “the performance of any work or labor and shall also include acting as an independent contractor or providing any consulting advice or assistance or otherwise acting as an agent pursuant to a contractual relationship.”

Contractor understands that it is not eligible to receive or retain a City contract if at the time the contract is executed, or at any time during the term of the contract it provides Personal Services to:

a. The governing regime in any Oppressive State.

b. Any business or corporation organized under the authority of the governing regime of any Oppressive State.

c. Any person for the express purpose of assisting in business operations or trading with any public or private entity located in any Oppressive State.

Vendor further understands and agrees that Vendor's failure to comply with the Resolution shall constitute a default of the contract and the City Manager may terminate the contract and bar Vendor from bidding on future contracts with the City for five (5) years from the effective date of the contract termination.

The undersigned is familiar with or has made a reasonable effort to become familiar with, Vendor's business structure and the geographic extent of its operations. By executing the Statement, Vendor certifies that it complies with the requirements of the Resolution and that if any time during the term of the contract it ceases to comply, Vendor will promptly notify the City Manager in writing.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Printed Name: ____________________________________ Title: _______________________________________

Signature: ________________________________________ Date: ______________________________________

Business Entity: ____________________________________________________________________________________

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