|
� r
<br /> . NON-COLLUSION AFFIDAVIT
<br /> ' RETURN WITH BID
<br /> ' � ^ /
<br /> STATE OF .1,,���-1(l.O..V', )
<br /> ) s
<br /> COUNTY OF �!�!,��
<br /> '
<br /> ' _.-
<br /> �- �,�,A
<br /> 'G�1S - (}�.�1 , being first duly sworn,
<br /> , deposes and says that they are �,2��,1�tt 1��,` (sole owner,partner,president,
<br /> secretary, etc.) of �1�1��pc�,�:l�-i,.,,�, [';9U;pq�,;�� L� , 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 /> i ' 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 wrll
<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 financtal interest with said bidder m their
<br /> general business.
<br /> '
<br /> '_ _._.
<br /> S' ned: I
<br /> � � � '�
<br /> ; f �
<br /> ' .%;r Title �:�v��--��
<br /> , Subscribed and sworn to before me this ��day of � , 2016.
<br /> �SEAL� MAR�AN Wq�TER
<br /> ' � , � OFFICIAL SEAL NOtaiy PUbI1C
<br /> i �< ,, Notary Pubhc.Stateof Illino�s
<br /> ����Y':e� My Commission Expnes
<br /> , Apn1 01, 2019
<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 /> '
<br /> '
<br />
|