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NON-COLLUSION AFFIDAVIT
<br /> STATE OF _::V—NI
<br /> COUNTY OF J )
<br /> RETURN WITH BID
<br /> T4Sew ��,/e-,-- , being first duly sworn,
<br /> and d says that they are lL�c„F„�/ , �si.Qt.l (sole owner,partner,President
<br /> secretary, etc.) of 7R,,o,-,4 the party making the
<br /> foregoing bid; that such bid is not made in the interest of or on behalf of 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 shall
<br /> refrain from bidding; that said bidder has not in any manner, directly or indirectly, sought by
<br /> agreement, communication or conference with anyone to fix the bid price of said bidder or of
<br /> any other bidder, or to fix any overhead,profit or cost element of such bid price, or of that of any
<br /> other bidder, or to secure any advantage against the public body awarding the contract or 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, submitted 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, association,
<br /> organization, bid depository, or to any member or agent thereof, or to any 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 /> Signed:
<br /> Title
<br /> Subscribed and sworn to before me this day of , 2014.
<br /> I,
<br /> (SEAL) t,,,, s,��
<br /> N y Public
<br /> >r'�TE •��
<br /> *The Owner reserveF§.Ab4?jfghi, before any award of contract is made, to require of any bidder to
<br /> whom it may ind Ce,an'a 4.d,,0f-the Contract, a duly executed non-collusion affidavit in the form
<br /> designated above-.-,'.
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