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• Annualized payroll at end of Reporting Period: <br />• Please list any final judicial determinations or admissions that Amazon or one of its Affiliates unlawfully <br />discriminated in violation of Section 3.01(a) of the Chapter 380 Agreement : [attach separate sheet] <br />The City Manager may agree to an amendment to this form from time to time, provided such amended form shall be <br />substantially similar in reporting the information necessary to confirm compliance with the Chapter 380 Agreement <br />and to calculate the Chapter 380 Payments. <br />Upon request of the City Manager, Amazon shall permit and cause its Affiliates to permit the City to conduct an <br />audit and inspection of Amazon's records in accordance with the terms of the Chapter 380 Agreement.. <br />I, [Insert name and title], certify that the foregoing information is true and <br />correct and that Amazon has materially complied with all terms and conditions of the Chapter 380 Agreement. <br />[Name and Title] <br />Date <br />28 <br />