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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 Ashl <br />, Indiana this <br />21 st <br />Bit -Mat Products of Indiana <br />day of March , 2022 <br />(Name of Organization) <br />By iillllll!"!: <br />of • Sign4) <br />ACKNOWLEDGEMENT <br />STATE OF Indiana <br />Steuben ) ss <br />COUNTY OF 1 <br />Before me, a Notary Public, personally appeared the above-named John Baumgartner and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this 21st day of March 2022 <br />My Commission Expires: 11/1/2024 <br />County of Residence: DeKalb <br />4mLj&�X&&L <br />Notary Publ c <br />IGmberly Smith <br />Notary Public, State of Indiana <br />SEAL toq";Zi i <br />County of DeKalb <br />My Commission Expires, j �Q �- <br />