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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 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 Vic..this l' /4, dayof /',o l , ao3r" <br />rY1ur'>< 0lS/� , P-esi dY'J <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT <br />STATE OF JWAQklGL ) <br />COUNTY OFF J(`�i�P ss <br />Before me, a Notary Public, personally appeared the above -named __ KUL os� and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this l 7f' day of ill nil <br />qw" �t L43 <br />Notary Public <br />My Commission Expires: III I�ip �„e„E�bg <br />11 Notary Public Sea! State of Indiana <br />Count of Residence: I�—/-I{ Elkhart County <br />y Commission Number NP0725779 <br />1�y Commission Expires 03/11/2028 <br />t. <br />