CERTIFICATE OF FAMILIARITY
The undersigned, having fully familiarized himself with the information contained within this entire
solicitation and applicable amendments, submits the attached proposal and other applicable information to
the County, which I verify to be true and correct to the best of my knowledge. I certify that this proposal is
made without prior understanding, agreement, or connection with any corporation, firm or person
submitting a proposal for the same materials, supplies or equipment, and is in all respects, fair and without
collusion or fraud. I agree to abide by all conditions of this proposal and certify that I am authorized to sign
this proposal. By submission of a signed proposal, I certify, under penalties of perjury, that the below
company complies with section 12-54-1020(B) of the SC Code of Laws 1976, as amended, relating to
payment of any applicable taxes. I further certify that this proposal is good for a period of ninety (90)
days, unless otherwise stated.
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Company Name as registered with the IRS
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Authorized Signature
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Correspondence Address
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City, State, Zip
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Date
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Printed Name
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Title
___________________________________
Telephone Number
LEXINGTON COUNTY VENDOR NUMBER ____________________________________
IF VENDOR NUMBER IS NOT SUPPLIED, THE BELOW SECTION MUST BE COMPLETED.
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Remittance Address
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City, State, Zip
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Fax Number
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Telephone Number
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Toll-Free Number if available
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Federal Tax ID Number
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SC Sales Tax Number
Option: Other commodities/services provided by your company.
Contractor’s License Number (#), if applicable: ____________________________________