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Ak <br /> NON-COLLUSION AFFIDAVIT <br /> STATE OF <br /> COUNTY OF <br /> RETURN WITH BID <br /> being first duly sworn, <br /> deposes and says that theX are riD a,-VX Ir (sole owner, partner, president, <br /> secretary, etc.) of 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 /> E OFFCKSEAL ned: <br /> MICHAEL E KIRK 1000' <br /> ,OTARY PUBLIC-STATE OF ILLINOIS C Z,5 <br /> My COMMISSION EXPIRES:03115/17 <br /> Title <br /> Subscribed and sworn to before me this day of Z , 2014. <br /> (SEAL) <br /> Notary Public <br /> *The Owner reserves the right, before any award of contract is made, to require of any bidder to <br /> whom it rnay make an award of the Contract, a duly executed non-collusion affidavit in the form <br /> designated above. <br /> 14 <br />