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40 <br />• <br />s <br />NO CHANGE AFFIDAVIT <br />'rw undersigned swears that the foregoing statements are true and correct aid int ude all material <br />information nacmary to identify and ertplam the operations of (name <br />of firm) as well as the ownership thereof Further, the undasigned agrees to provide, through the <br />prime contractor or, if no prime, directly to the gree, cuMM complete and accurate information <br />regarding actual wait pa£ormed on the project, the payment tberd re, and any proposed &tnges, <br />if any, of the foregxrittg artacrgements tad to permit the art& aid ammation of books, records. and <br />files of the named firm. Any material misrepresentation wW be grounds for tamviaangg any, <br />contract which may be awarded and for milia tm action under Federal and State laws cor>cauing Use <br />statmtem <br />Note: 14 after filing this Schedule A and before the work of this firm is cowfieted of the coatratx <br />covered by this regulation, there is any significant change in the information submitted, you must <br />inform the grantee of the change through the prime contractor or, if no prime contractor, inform the <br />grantee directly. <br />Signature: <br />Name (Print or Type): <br />Title: <br />Date: <br />Corporate Seal (where appropriate): <br />iI <br />State of <br />county or <br />On this day of , 19_, before me appeared <br />(name), to me personally known, who, being duly sworn, did etoecttte the fixegoing <br />affidavit, and did state that he or she was property authorized by (name of firm) <br />. to execute the affidavit and did so as his or ber free act ad deed, <br />(Seal) <br />Notary Public: <br />Commission expires: <br />ATTACHMENT E <br />-26- <br />