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AGREEMENT between HEWLETT‐PACKARD COMPANY and INSURE OKLAHOMA - page 4 / 4

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AFFIDAVIT [Required by 74 Okla. Stat. §§ 85.23 and 85.43 (B)]

STATE OF

)

)

ss.

COUNTY OF

)

of lawful age, being first duly sworn on oath says: (Print Name of Person Signing Agreement)

  • 1.

    He/She is the duly authorized agent of the EMPLOYER under the Agreement which is attached to this statement, for the purpose of certifying the facts pertaining to the giving of things of value to government personnel in order to procure said Agreement;

  • 2.

    He/She is fully aware of the facts and circumstances surrounding the making of the Agreement to which this statement is attached and has been personally and directly involved in the proceedings leading to the procurement of said Agreement;

  • 3.

    Neither the EMPLOYER nor anyone subject to the EMPLOYER’s direction or control has paid, given, or donated or agreed to pay, give or donate to any officer or employee of the State of Oklahoma any money or other thing of value either directly or indirectly, in procuring the Agreement to which this statement is attached; and

  • 4.

    No person who has been involved in any manner in the development of the Agreement to which this statement is attached while employed by the State of Oklahoma shall be employed to fulfill any of the services provided for under said Agreement. This paragraph shall not preclude faculty and staff of institutions within the State system of Higher Education from negotiating and participating in research grants and educational contracts. This paragraph shall not apply to an agreement between the Oklahoma Health Care Authority and another agency of the State of Oklahoma.

Employer’s Signature

Subscribed and sworn before me this

day of

_, 20

( Seal )

Notary Public (or Clerk or Judge)

Insure Oklahoma/HP/Employer Contract 7-8-11

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