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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 />SECTIONV 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 19th day of December 2017 <br />TGB 'Unlimited (dba) SJT Bancroft Electric <br />(Name of organization) <br />President <br />(Title of Person Signing) <br />ACKNOWLEDGEMENT <br />STATE OF Indiana <br />COUNTY OF St. Joseph ) ss <br />Before me, a Notary Public, personally appeared the above -named Ty Bancroft and <br />swore that the statements contained In the foregoing document are true and correct. <br />Subscribed and sworn to before me this 19th <br />day ofDe ta..er 2017 <br />..., ,. _.. „ Notary <br />Public <br />M Commission Expires: June 18, 2023. <br />y p <br />dp, <br />I,'I lJlvi ARTI <br />Nouary <br />Public, SWO Of indiana <br />County of Residence. LaPorte <br />°,�[ AU <br />IMMr^jri�srwr� <br />k,aForteCOLIMy <br />�'. My <br />Commission Expires <br />Jain 18, 2023 <br />M. <br />