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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 b-y 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 LaPorte, IN this 13th day of October 2020 <br />Larson -Danielson Construction Co., Inc. <br />�..) (Name of Organization) <br />711 <br />Timothy F. Larson, President <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT CARBON DANIELSON <br />.. ....R <br />STATE OF Indiana %%SEA.; CONSTRUCTION CO., INC, <br />) .S..S. fi'OIANp' <br />COUNTY OF LaPorte <br />Before me, a Notary Public, personally appeared the above -named Timothy F. Larson and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this 13th day of October 2020 <br />My Commission Expires: September 8, 2023 <br />County of Residence: LaPorte <br />{ <br />/......... <br />........ <br />Notary P <br />Michele C. Dzielinski <br />MICHELECECELIADZIELINSKI <br />* = <br />La Forte County <br />' e <br />M Commission <br />eptember 8, 2023Q� <br />