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SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT <br />The undersigned bidder or agent, being duly swom 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 2' _ day of October__ , 2021 <br />♦���`,%tracto <br />.o g <br />N ; �p4P0RA ';� — <br />'V%. SEAL <br />STATE OF Indiana <br />) ss <br />COUNTY OF St. Joseoh� ? <br />North, Inc. <br />(Name of organization) <br />Director of Estimatin <br />(Tide o€Person Signing) <br />ACKNOWLEDGEMENT <br />Before me, a Notary Public, personally appeared the above-named Dustin P. Hilary <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this _26th <br />My Commission Expires: 6/5/22 <br />County of Residence: LaPorte <br />day of ,_._—October _ , 2021 <br />and <br />4"N46,yP�,bfi�ashaeger <br />4Fo P Y^�6n <br />�ALISHA KRUEGER <br />" NOTARY = <br />LaPorte County <br />.,5 :2== <br />My Commission Expires <br />of "°s <br />June 5, 2022 <br />