BIDDER�S CERTIFICATION OF COMPLIANCE WITH

IRAN DIVESTMENT ACT

Pursuant to General Municipal Law �103-g,

General Municipal Law � Section 103 (G)

4. Every bid or proposal hereafter made to a political subdivision� of

� the� state� or� any� public department, agency or official thereof where

� competitive bidding is required by statute, rule,� regulation� or� local

� law,� for work or services performed or to be performed or goods sold or

� to be sold, shall contain the� following� statement� subscribed� by� the

� bidder� and� affirmed� by� such� bidder� as� true under the penalties of

� perjury:

��� a. "By submission of this bid, each bidder and each person signing� on

� behalf� of� any� bidder� certifies,� and in the case of a joint bid each

� party thereto certifies as to its own� organization,� under� penalty� of

� perjury,� that� to the best of its knowledge and belief that each bidder

� is not on the list created pursuant to paragraph (b) of subdivision 3 of

� section 165-a of the state finance law."

��� b. Notwithstanding paragraph a of this subdivision, the� statement� of

� non-investment�� in�� the�� Iranian�� energy� sector� may� be� submitted

� electronically in accordance with the provisions of subdivision� one� of

� section one hundred three of this article.

��� c. A bid shall not be considered for award nor shall any award be made

� where the condition set forth in paragraph a of this subdivision has not

� been� complied� with;

which generally prohibits the Town from entering into contracts with persons engaged in investment activities in the energy sector of Iran, the bidder / proposer submits the following certification:

By submission of this bid or proposal, each bidder / proposer and each person signing on behalf of any bidder / proposer certifies, and in the case of a joint bid each party thereto certifies as to its own organization under penalty of perjury, that to the best of its knowledge and belief, that each bidder / proposer is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law.

Dated:������������ _______________________________, New York

�����������������������

����������������������� ________________________________, 20___

Signature

Printed Name

Title

Sworn to before me this __________ day of _____________________________, 20_____

Notary Public�������������������������������������������������������������������������������������������������

Dated: