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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 South Bend this <br />Milesto <br />STATE OF Indiana <br />COUNTY OF St. Joseph ss <br />) <br />day of October 12023 <br />Borth, Inc. _ <br />(Name o�gsn�zation) <br />'tin 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. Hilary and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this 24th day of October 2023 <br />Notary Public <br />My Commission Expires: June 5, 2030 <br />County of Residence: LaPorte <br />O�FpY { ve <br />ALISHA KRUEGER <br />*Commission Expires <br />=* SEAL :* <br />June 5, 2030 <br />Commission Number NP0653544 <br />La Porte County <br />