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NQN-COLLUSION AFFIDAVIT
<br /> RETURN WITH BID
<br /> STATE OF ��linois �
<br /> )ss
<br /> COU1�tTY 4F Macon )
<br /> Jeffrey S Burdick , bein� first duly s�vom,
<br /> deposes and says that they are `•f. ('._�-�,„r�; (sole owner,partner,prasiden�
<br /> secretary, etc,) of ���s_,> ,„-i- 1 f�.�,,r�t,;,)c,�•=+ �-� (cr;-�;�t� C4�1-��c, the party making the
<br /> foregoing bid; that such bid is not made in the interest of or on behalf af any undisclosed person,
<br /> partnership, company, association, organization or corporation; that such bid is genuine and not
<br /> collusive or sham; that said bidder has not directly or indirectly induced or solicited any other
<br /> bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired,
<br /> connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shail
<br /> refrain from bidding; that said bidder has not in any manner, directly or indirectiy, sought by
<br /> agreement, communication or conference tivith anyone to fix the bid price of said bidder or of
<br /> any other bidder,or to fix any averhead, profit or cost element of such bid price,ar of that of any
<br /> other bidder,or to secure any advantage against the public body awarding the contract ar anyone
<br /> interested in the proposed contract; that all statements contained in such bid are true; and,
<br /> further,that said bidder has not,directly or indirectly,submifted their bid price or any breakdown
<br /> thereof; or the contents thereof,or divulged information or data relative thereto, or paid and will
<br /> not pay any fee in connection therewith to any corporation, partnership, company, associatian,
<br /> organization, bid depository,or to any member or agent thereof, or to an}�other individual except
<br /> to such person or persons as have a partnership or other financial interest with said bidder in their
<br /> general bUsiness.
<br /> �----
<br /> Signed: --
<br /> V�President
<br /> Title
<br /> Subseribed and swom to before me this 20th day of February , 2019.
<br /> (SEAL)
<br /> Notary Public
<br /> *The Owner reserves the right, before any award af contract is made, to require of any bidder to
<br /> whom it may make an award of the Contract, a duly executed non-collusion affidavit in the farm
<br /> designated above.
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