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' NON-COLLUSION AFFIDAVIT <br /> ' STATE OF <br /> ' COUNTY OF <br /> ' RETURN WITH BID <br /> 1 1 <br /> being first duly sworn, <br /> deposes and says that are Of r^ (sole owner,partner, president, <br /> ' secretary, etc.) ofthe /1 r ,D` 4 the party making the <br /> foregoing bid; that such bid is not made in the interesg interof 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 /> A C PAVEMENT STRIPING CO. <br /> ' Signed: <br /> ' (title WILLIAM BRINATI <br /> CORPORATE SECRETA`;' <br /> ' Subscribed and sworn to before me this �,n day of NU p,,A , 2012. <br /> `OFFICIAL SEAL" <br /> (SEAL) THERESE J.TABOR , <br /> ' Notary Public,State of Illinois Notary P is <br /> My Commission Expires 3-29.2016 <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 /> 14 <br />