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NON-COLLUSION AFFIDAVIT <br /> E RETURN <br /> STATE OF ll�NOi S ) <br /> ss <br /> COUNTY OFAA&COUL. <br /> __ , being first duly sworn, <br /> deposes and says at t ey are (sole owner,partner, president, <br /> secretary,etc.) of ,the party making the foregoing <br /> bid;that such bid is not made in the interes of or on behalf of any undisclosed person,partnership, <br /> company, association, organization or corporation; that such bid is genuine and not collusive or <br /> sham; that said bidder has notit <br /> d ectly or indirectly induced or solicited any other bidder to put in <br /> a false or sham bid,and has not directly or indirectly colluded,conspired,connived,or agreed with <br /> any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that said <br /> bidder has not in any manner, directly or indirectly, sought by agreement, communication or <br /> conference with anyone to fix the bid price of said bidder or of any other bidder, or to fix any <br /> overhead, profit or cost element of such bid price, or of that of any other bidder, or to secure any <br /> advantage against the public body awarding the contract or anyone interested in the proposed <br /> contract; that all statements contained in such bid are true; and, further, that said bidder has not, <br /> directly or indirectly, submitted their bid price or any breakdown thereof, or the contents thereof, <br /> or divulged information or data relative thereto, or paid and will not pay any fee in connection <br /> therewith to any corporation, partnership, company, association, organization, bid depository, or <br /> to any member or agent thereof,or to any other individual except to such person or persons as have <br /> a partnership or other financial interest with said bidder in their general business. <br /> Signed: <br /> Titl' ✓evaej <br /> Subscribed and sworn to before me this �Cl da of �� � �r , 2016. <br /> V=wnerreserves <br /> KU HLE AL SEAL <br /> 4 �r <br /> NOTILLINOIS Notary Public <br /> MY10/27/16 <br /> rves e 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 /> 26 <br />