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whose address is <br />a) Employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration, <br />to solicit or secure this AGREEMENT; <br />b) Agreed, as an express or implied condition for obtaining this contract, to employ or retain the services of <br />for me or the above CONSULTANT) any fee, contribution, donation, or consideration of any kind for, or in <br />connection with, procuring or carrying out this AGREEMENT; except as hereby expressly stated (if any); <br />and the Federal Highway Administration, U.S. Department of Transportation in connection with this <br />AGREEMENT involving participation of Federal-aid highway funds, and is subject to applicable State and <br />Federal laws, both criminal and civil. <br />Consultant (Firm Name) <br />Date <br />Agreement Number: <br />Exhibit <br />06/18/2026