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r <br />PART IV: AFFIDAVIT <br />The undersigned, being duly sworn, deposes and says that the foregoing is a true statement of <br />facts concerning the sole proprietorship, corporation, co-partnership or joint venture herein <br />named, as of the date indicated; that the answers to the foregoing interrogatories are true; that <br />this statement is for the express purpose of inducing the Platte River Recovery Implementation <br />Program to award the said firm or individual a contract; and that any depository, vendor, or <br />other agency herein named is hereby authorized to supply the Platte River Recovery <br />Implementation Program or its agent with any information #o verify this statement. <br />Name of Firm <br />Authorized Signature <br />Subscribed and sworn to me this day of <br />Notary Public in and for the State of <br />Residing at <br />Notary Seal <br />Statement Prepared By <br />Title Date <br />Page 6 of 6