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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 WORK"RE TRUE AND CORRECT. <br />Dated at South Bend <br />��``N%,1u11rr11M <br />O�Cta[tors <br />.............�,o i <br />•• e, By <br />e o.• �PORAiF •�S <br />s � <br />����,, ' N d6� xNN`e�� <br />STATE OF Indiana <br />COUNTY OF St. Joseph )ss <br />3rd day of August , 2022 <br />k6rs North, Inc. <br />(Name <br />P. Hilary, Director of Estimating <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT <br />Before me, a Notary Public, personally appeared the above-named ._ Dustin P. Hilaryand <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this 23rd day of August 2022 <br />Notary Public <br />My Commission Expires: June 5, 2030 <br />County of Residence: LaPorte <br />� - <br />&USM KRUEGERSEAL <br />June5,2030 <br />=a 0 <br />.9 ��.• <br />C4mn1rJwNumber NPP0SSW <br />; <br />u Porte ea. <br />