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representative in support of *are accurate, complete, and current <br />**as of . <br />Firm: <br />Signature Title <br />Date of Execution***: <br />* <br />**Insert the day, month, and year, when price negotiations were concluded and price AGREEMENT was reached. <br />***Insert the day, month, and year, of signing, which should be as close as practicable to the date when the price negotiations were concluded and the <br />contract price was agreed to. <br />Agreement Number: <br />Exhibit