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� �
<br /> NON-COLLUSION AFFIDAVIT
<br /> ' RETiJRN WiTH RiD
<br /> � STATE OF I L,L.I ►LJdtS )
<br /> ) ss
<br /> � COUNTY OF M(�y���"(',�p{y�F{(,t.-1 )
<br /> �
<br /> ���� �y� � ��(1�J ►��J , being first duly sworn,
<br /> , deposes and says that they are � ,�SI��--Irt" (sole owner, partner, president,
<br /> secretary, etc.) of (I\�n.l��► �, I a b�9 ?�1C. , 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 /> �
<br /> � Signed:
<br /> , �
<br /> � Title
<br /> ' Subs� ' an�nr•�n to 13,P�r�m ' �_day of C��)�I C , 2016.
<br /> ��'FICIAL SEAL
<br /> SEAL t ''f*N�DAVENPORT
<br /> � � �''��+t�TARY PUBLIC,STATE OF ILLINOIS Not Public
<br /> � ;:v�y Commission Expines 08-21-1T
<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 /> f
<br /> � 22
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