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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 South Bend this 14th day of May 2021 <br />Milestone or to orth, Inc. <br />``,��141 (Name of Organization) ~ <br />�`. �tCdCtprs�O/A ' B <br />DMO iiary <br />? c ��pORAre Director of EstimatinQ,_Sou#h Bend <br />_ c _ -- <br />+ •+ Crlde of Person Signing) <br />����'i • bNblCa� N ACKNOWLEDGEMENT <br />�Iiii11 <br />STATE OF Indian } <br />} ss <br />COUNTY OF St. Joseph <br />Before me, a Notary Public, personally appeared the above-named Dustin P. Hilary _ and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this 11 thday of May <br />Notary Public rrisha Krueger <br />My Commission Expires: 6/5/22 <br />4•.r ALISHA KRUEGER <br />County of Residence: St O kph:Notary PuF�Iic, State of Indiana <br />1 St.JosephCounty <br />My Commission Expires <br />.' c°' June 05, 2022 <br />