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' NON-COLLUSION AFFIDAVIT <br /> ' STATE OF IMiS rop4Z ) <br /> COUNTY OF S-f) ss /�^l>✓s ) <br /> RETURN WITH BID <br /> -D \�I git being st duly sworn, <br /> ' deposes and says that they arey 1 uL ?c.e--,)pe KFT- (sole owner,partner,president, <br /> secretary, etc.) of SRS �xS taC,T+r�N r )-L�c , the pz ity making the <br /> ' foregoing bid;that such bid is not made in the interest of or on behalf of any w tdisclosed person, <br /> partnership, company, association, organization or corporation; that such bid i3 genuine and not <br /> collusive or sham; that said bidder has not directly or indirectly induced or s licited 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 ind ctly, 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 s id bidder in their <br /> ' general business. <br /> ' Signed: <br /> ' Title <br /> ' Subscribed and sworn to before me this day of v 41 )2015. <br /> (SEAL) / <br /> 0 <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 may make an award of the Contract, a duly executed non-collusion affidavit in the form <br /> designated above. <br /> ' Troy Bradshaw <br /> Notary P lic Notary Seal <br /> 20 State of Misso d County of Warren <br /> My Commisei Expi es 12111/2015 <br /> Commi on#11410273 <br /> t <br />