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BID FORM <br />NON -COLLUSION AFFIDAVIT OF PRIME BIDDER <br />STATE OF INDIANA, <br />COUNTY OF LA PORTE: <br />Todd R. Bell , being first duly deposes and says that; <br />1. He is (Owner, VICE-PRESIDENT, Officer) of WOODRUFF & SONS. INC that Bidder <br />has submitted the attached Bid; <br />2. He is fully informed respecting the preparation and contents of the attached bid and of all <br />pertinent circumstances respecting such Bid; <br />3. Such Bid is genuine and is not a collusive or sham Bid; <br />4. Neither the said Bidder nor any of its Officers, Partners, Owners, Agents, Representatives, <br />Employees, or Parties of Interest, including the Affiant, has in any way colluded, conspired, <br />connived, or agreed, directly of indirectly with any other bidder, firm or person to submit a <br />collusive or sham bid in connections with the Contract for which the attached Bid has been <br />submitted or to refrain from bidding in connections with such Contract, or has in nay manner <br />directly of indirectly, sought by agreement or collusion or communication or conference with any <br />other Bidder, firm or person to fix the price or prices in the attached bid, or of any other bidder, <br />or to fix any overhead, profit or cost element of the bid price of the bid price of any other bidder, <br />or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage <br />against the Owner or any person interested in the proposed Contract, and <br />5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any <br />collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its <br />agents, representatives, owners, employees, or parties in interest, including the afiant. <br />Signed:_1�/� <br />Title: Todd R. Bell, Vice President <br />Subscribed and sworn to before me this 18th day of Au ust 2016 <br />i ne . 1 �rner, Notary Public <br />My Commission Expires: January 2. 2024 <br />A Resident of: LA PORTE COUNTY, INDIANA JAYNE A. KARNER <br />Seal <br />Notary public - State of Indiana <br />La,Pgrte County <br />My Commission Expires Jan 2, 2024 <br />