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Exhibit G <br /> B. No department director or any employee or any officer of the City of Decatur has any financial <br /> interest, direcdy or indirectly,in the award of this contract except as listed on a separate attached <br /> sheet to this affidavit. <br /> C. That the Professional Service Provider is not barred from bidding on any contract as a result of <br /> violation of 720 ILCS 5/33E-3 and 5/33E4(Bid Rigging or Bid Rotating). <br /> SECTION M. 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 580/1,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 Illinois <br /> Department of Revenue for the payment of all taxes due and is in compliance with the agreement. (65 <br /> ILCS 5/1142.1-1) <br /> SECTION IV. FAMILIARITY 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 include,but is not limited to,the Prevailing Wage Act and the Davis-Bacon Act. <br /> 7#= <br /> E PROVIDER <br /> U%,nature <br /> Wg� <br /> Printed Name <br /> 'Pj4vav f <br /> Tide <br /> SUBSCRIBED and SWORN to before me this ►-0day of &U6UST ,20_ <br /> Notary Public <br /> OFFiCIAI.SEAL <br /> S KIMBERLY A GOSS <br /> ,"-CRYPL6X-8TA7E0FL N= <br /> '�hNSBiQN E0�115 <br /> G-3 <br />