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FOREIGN OWNERSHIP, CONTROL, OR INFLUENCE (FOCI) DETERMINATION DOCUMENTS (5-99) - page 10 / 16

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REMARKS (Attach additional sheets, if necessary, for a full detailed statement.)

CERTIFICATION

I CERTIFY that the entries made by me above are true, complete, and correct to the best of my knowledge and belief and are made in good faith. WITNESSES:

(Date Certified)

By

(Contractor)

NOTE: In case of a corporation, a witness is not required but the certificate below must be completed. Type or print names under all signatures.

(Title)

(Address)

NOTE: Contractor, if a corporation, should cause the following certificate to be executed under its corporate seal, provided that the same officer shall not execute both the Agreement and the Certificate.

CERTIFICATE

I,

, certify that I am the

of the corporation named as Contractor herein; that

who signed this certificate on behalf of the Contractor, was then

of said corporation; that said certificate was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers.

(Corporate Seal) STANDARD FORM 328 (BACK) (4/1997)

(Signature and Date)

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