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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 _ *CL-, this day of <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT <br />STATE OF <br />COUNTY OF J�`�(� ss <br />Before me, a Notary Public, personally appeared the above-named RUL OSV and <br />swore that the statements contained in the foreqoing document are true and correct. <br />Subscribed and sworn to before me this _ Y P day of in e_ <br />Notary Public <br />My Commission Expires: <br />I <br />Count of Residence:_ Imo/ I1 <br />County <br />Hea„enEdwards <br />FNZotary Public Seal Stele of Indiana <br />Elkhart c°"rq' <br />mission Number NP0725779 <br />My Commission Expires 03/11/2028 <br />`TY <br />