R2015-91 APPROPRIATE ADDITIONAL MOTOR FUEL TAX FUNDS FOR RESTORATION OF STREETS AND HIGHWAYS

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NON-COLLUSION AFFIDAVIT RETURN WITH BID 1 STATE OF Illinois ) ) ss COUNTY OF Sangamon ) James P.Bruner being first duly sworn, deposes and says that they are President (sole owner,paitner,president, secretary, etc.) of Illinois Valley Paving,a Div of UCM,Inc. , the party making the foregoing bid; that such bid is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder has not directly or indirectly induced or soli ited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or th it anyone shall refrain from bidding; that said bidder has not in any manner, directly or ind' tly, sought by agreement, communication or conference with anyone to fix the bid price of said bidder or of any other bidder,or to fix any overhead,profit or cost element of such bid price, CT of that of any other bidder, or to secure any advantage against the public body awarding the contract or anyone interested in the proposed contract; that all statements contained in such bid are true; and, further,that said bidder has not,directly or indirectly, submitted their bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith to any corporation, partnership, company, association, organization,bid depository, or to any member or agent thereof, or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in their general business. Si Title President Subscribed and sworn to before me this 27th day of TnIv 2015. OFFICIAL SEAL �/ I (SEAL) MARTHA LOU THORNLEY Not is NOTARY PUDIC,STATE OF ILLINOIS MY COMMISSION EIfPIRES 9—2015 *The Owner reserves the right,before any award of contract is made,to require o any bidder to whom it may make an award of the Contract, a duly executed non-collusion affi it in the form designated above.