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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 />1 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 . _ <br />Milestone <br />actors /y �i <br />N` <br />o . ,.. .. ,o,�� eee' By <br />ORATE <br />..c:•OF�AO :^y <br />S <br />STATE OF Indiana <br />) ss <br />COUNTY OF St. Joseph <br />day of _ . Janua <br />of <br />Director of Estimating <br />(r+tle of Person Signing) <br />ACKNOWLEDGEMENT <br />2022 <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 _ 25th day of January 2Q22 <br />JAI <br />NotaryPut,fic sha Krueger <br />6/5/22 .. <br />My Commission Expires: _ S�A�•. <br />o. <br />I! _= <br />Nernav . <br />==KRUEGER <br />County of Residence: St.Joseph s� s <br />M <br />i <br />