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I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE <br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH t (OfNEI ABOVE IS FOR THAT PUBLIC ENTITY ONLY A' <br />THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FII. <br />I ALSO UNDERSTAND THAT 1 AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERIN< <br />INTO A CONTRACT IN EXCESS OF I HE THRESHOLD MIOUNT PROVIDED IN SECTION 297.0/7, <br />FI,OR IDA STATI TFC FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN <br />THIS FORM. <br />(sign'emre7 <br />00 <br />(data) <br />STATE OF Choc <br />COUNTY OF -J�a,r`t, I n <br />PERSONALLY APPEARED BEFORE ME, the undersigned authority, <br />R Ck- d ~e � (no=ofindividual signing] <br />whn, pf¢ otbeMg sworn by...Rued Ns/hersignature in the space provided above on this 3LD day of <br />iJA U3X <br />—2000 <br />My commission expires: <br />sard 4MnA=6$ <br />MCOM1VaISRON/ CCNDFA9PF5 <br />wwornrv�a4u'wNwuxuuic <br />b <br />Form PUR 7068 (Rev. 04/10/91) <br />DOR-1 <br />NOTARA . ��tit <br />N Y PUBLIC <br />