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Exhibit G <br /> C. That the Professional Service Provider is not barred from bidding on any contract as a resutt of <br /> violatioi�of 720 TLCS 5/33E-3 and 5/33E-4(Bid Rigging or Bid Rotating). <br /> SECTION III. DRUG FREE WORKPLACE AND DELINQUENT ILLINOIS TAXES STATEMENT <br /> The undersigned states under oath that the Professional Service Provider is in full compliance with the <br /> Illinois Drug Free Workplace Act, 30 ILCS 580/l, et.seq. The undersigned also states under oath and � <br /> certifies that the Professional Service Provider is not delinquent in payment of any tax administered by <br /> the Illinois Department of Revenue except that the taxes for which liability for the taxes or the amount of <br /> the taxes are being contested in accordance with the procedures established by the appropriate Revenue <br /> Act; or that the Professional Service Provider has entered into an agreement(s)with the Itlinois <br /> Department of Revenue for the payment of all taxes due and is in compliance with the agreement. (65 <br /> ILCS 5/11-42.1-L) <br /> SECTION IV. FAMILtARITY WITH LAWS STATEMENT <br /> The undersigned, being duly sworn,hereby states that the Professional Service Provider and its <br /> employees are familiar with and will comply with all Federal, State and local laws applicable to the <br /> project,which may rnclude, but is not limited to,tlie Prevailing'VVage Act and the Davis-Bacon Act. <br /> PROFESSIONAL SERVICE PROVIDER <br /> �J !i � �--� <br /> ignature <br /> U 2 i+t k l�S J • t`�'7� t l a,/�a.tn <br /> Printed Name <br /> U- �• <br /> Title <br /> SUBSCRIBED and SWORN to before me this o� day of � , 20�. <br /> � � � - <br /> ` Notaty Public <br /> OFFIC:lA: SEAI. <br /> DAWN <. �-s�R��NGER <br /> N�)tARY F'l Ilif�,. ���,:; �)t ILLlNp[S <br /> My C4n�nus:a. � ,,�pne� .�an 23."1E122 <br /> ,,,�,,,_ .,:�,s , <br /> � G-3 <br />