Does Supplier agree? YES ________ Initials of Authorized Representative of Supplier SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier’s Name: _______________________________________________________________________________________ Address, City, State, and Zip Code: ________________________________________________________________________ Number: ____________________________________ Fax Number: ____________________________________ Printed Name and Title of Authorized Representative: __________________________________________________________ Email Address: Signature of Authorized Representative: _____________________________________________________________________ Date: ___________________________ FORM H: EXCEPTION FORM
Does Supplier agree? YES ________ Initials of Authorized Representative of Supplier SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier’s Name: _______________________________________________________________________________________ Address, City, State, and Zip Code: ________________________________________________________________________ Number: ____________________________________ Fax Number: ____________________________________ Printed Name and Title of Authorized Representative: __________________________________________________________ Email Address: Signature of Authorized Representative: _____________________________________________________________________ Date: ___________________________ FORM H: EXCEPTION FORM
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