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6D 12
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11/1/2012 2:24:42 PM
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6/10/2011 1:03:27 PM
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Affidavit of Non - Collusion <br />State of Indiana <br />MIA <br />County of St. Joseph <br />The undersigned, being first fully sworn, deposes and says that: <br />He /she is:[] owner, ❑ partner, ❑ officer, ❑ representative, <br />❑ agent, of <br />(applicant); <br />2. He /she is fully informed respecting the preparation and contents of the attached offer and <br />of all pertinent circumstances respecting such offer; <br />Such offer is genuine and not a collusive or sham offer; <br />4. Neither said Applicant nor any of its officers, partners, owner's agents, representatives, <br />employees, or parties in interest, including this affiant, has in any way colluded, <br />conspired, connived, or agreed directly or indirectly, with any other Applicant, firm or <br />person to submit a collusive or sham offer in connection with the Contract for which the <br />attached offer has been submitted or to refrain from making an offer in connection with <br />such Contract, or has in any manner, directly or indirectly, sought by agreement or <br />collusion or communication or conference with any other Applicant, firm or person to fix <br />the price or prices in the attached offer, or of any other Applicant, or to fix any overhead, <br />profit, or cost element of the offering price of any other Applicant, or to secure through <br />any collusion, conspiracy, connivance or unlawful agreement any advantage against the <br />City of South Bend and/or its Department of Redevelopment and/or the South Bend <br />Redevelopment Commission person interested in the proposed Contact; and <br />The price or prices quoted in the attached offer are fair and proper and are not tainted by <br />any collusion, conspiracy, connivance, or unlawful agreement on the part of the Applicant <br />or any of its agents, representatives, owners, employees or parties in interest, including <br />this affiant. <br />Before me, the undersigned, a Notary Public, <br />Non - Collusion on this <br />(Seal) <br />A resident of <br />day of <br />County, <br />0 <br />Afant <br />Signature <br />Title <br />subscribed and swore to this Affidavit of <br />Notary Public <br />
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