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�\ o,•" U'N 1KA(,1 Vl( l�lr tt®�V i l.V 1 1 Li1J1\1u'1trA11Vt <br />yR yY. fLOP� F <br />[PURSUANT To FLORIDA STATUTE § 287.1351 <br />on behalf of a 5�' <br />Print Name Company Nam <br />certifies tha -�Conm�p <br />-r1s5 e does not: <br />y Name <br />1. Participate in a boycott of Israel; and <br />2. Is not on the Scrutinized Companies that Boycott Israel list; and <br />3. Is not on the Scrutinized Companies with Activities in Sudan List; and <br />4. Is not on the Scrutinized Companies with Activities in the Iran Terrorism <br />Sectors List; and <br />5. Has not engaged in business operations in Cuba or Syria_ <br />Signature <br />Title <br />Date <br />