This agreement between

☒

OSU Center for Health Science,

☐

OSU-Tulsa,

herein after referred to as the University, and

herein after referred to as the Speaker.

(name of Speaker)

The Speaker agrees to appear at

at

(location in including address)

(time or length of time)

on

. The University will pay the Speaker a total amount

(date(s) when speaking)

of

for this speaking engagement.

($ amount of total fees)

The agreed amount is inclusive of any and all charges that may be incurred by the Speaker. This contract cannot be modified unless agreed to in writing by both parties.

I certify that:

1. I am the duly authorized agent of,

, the bidder and/or contractor, submitting the competitive

(company/vendor name)

bid and/or procuring the contract for the purpose of certifying the facts pertaining to the existence of collusion among bidders and between bidders and state officials or employees, as well as, facts pertaining to the giving or offer of things of value to government personnel in return for special consideration in the letting of any contract pursuant to said bid and/or procurement of the contract;

2. I am fully aware of the facts and circumstances surrounding the making of the bid and/or the procurement of the contract and have been personally and directly involved in the proceedings leading to the submissions of such bids; and
3. Neither the bidder/contractor’s direction or control has been a party:
1. to any collusion among bidders and/or contractors in restraint of freedom of competition by agreement to bid at a fixed price or to refrain from bidding,
2. to any collusion with any state official or employee as to quantity, quality or price of the prospective contract, or as to any other terms of such prospective contract, nor
3. in any discussions between bidders and/or contractors and any state official concerning exchange of money or other thing of value for special consideration in the letting of a contract,
4. to paying, giving or donating or agreeing to pay, donate to any officer or employee of the State of Oklahoma, any money or other  thing of value, either directly or indirectly, in procuring this contract.

*The information entered below should reflect who will receive payment.

FIRM

FEI/SSN#

DATE

(company or vendor name)

SIGNED BY

NAME

(name & title)

(please print)

ADDRESS

CITY, STATE, ZIP

PHONE

FAX

EMAIL

This submitted as a legal offer and acceptance by the Oklahoma State University Purchasing Department constitutes a binding contract.

OSU Reference:

Department

Account#

Contact

Phone