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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 ____________________ this ______________ day of __________________, _______ <br /> __________________________________________________________ <br /> (Name of Organization) <br />By________________________________________________________ <br /> __________________________________________________________ <br /> (Title of Person Signing) <br />ACKNOWLEDGEMENT <br />STATE OF ______________________) <br /> ) ss <br />COUNTY OF_____________________) <br />Before me, a Notary Public, personally appeared the above-named _________________________________ and <br />swore that the statements contained in the foregoing document are true and correct. <br />Subscribed and sworn to before me this ____________ day of ___________________, ________. <br /> ____________________________________________ <br />Notary Public <br />My Commission Expires:_____________________ <br />County of Residence:________________________ <br />Larson-Danielson Construction Co., Inc. <br />Brian T. Larson, President <br />Indiana <br />LaPorte <br />Brian T. Larson <br />September 8, 2031 <br />LaPorte <br />LaPorte, IN 12th December 2024 <br />X <br />12th December 2024 <br />X <br />Michele C. Dzielinski <br />LARSON-DANIELSON <br />CONSTRUCTION CO., INC. <br />S T A TE OF <br />INDIA AN <br />SEAL <br />C orporate <br />UBL <br />P <br />I <br />CYRATON <br />F I N D IANAOET <br />ATS NOTARY <br />SEAL <br />Michele Dzielinski Digitally signed by Michele Dzielinski <br />DN: C=US, E="mcd@ldconstruction,.com", <br />CN=Michele Dzielinski <br />Date: 2024.12.10 07:42:43-06'00'