Laserfiche WebLink
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT <br />The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other <br />member, representative, or agent of the firm, company, corporation or partnership represented by him, entered <br />into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is <br />made without reference to any other bid and without any agreement, understanding or combination with any other <br />person in reference to such bidding. <br />He further says that no person or persons, firms, or corporation has, have or will receive directly or <br />indirectly, any rebate, fee, gift, commission or thing of value on account of such sale. <br />SECTION V OATH AND AFFIRMATION <br />I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION <br />CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. <br />Dated at this 1{k day of ,Ce rK A6 <br />Bokon Masonry Inc. <br />°J P�,� HOLLY M. BELLEGANTE, I <br />Notary Public <br />0 SEAL Wrhn and for the county of LaPode <br />and the state of Indiana - <br />Commission Number NP0716379 <br />My Commission Expires 10/17/2026 <br />STATE OF <br />) ss <br />COUNTY OF W^ ) <br />(Name <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT <br />Before me, a Notary Public, personally appeared the above -named % and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this day of ) <br />Qil- <br />4=Ao-ov'�1 ��o - rn.11D <br />Notary Pubfic <br />My Commission Expires: % <br />County of Residence: -J Q� <br />