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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,%ARE TRUE AND CORRECT. <br />Dated at South Bend th <br />pN�ortfacto s'1�i�i� <br />of • �4 0 RA : S' <br />Nb1 Q*"'%X <br />IAAt <br />By <br />STATE OF Indiana ) <br />COUNTY OF St. Joseph ss <br />day of May 2023 <br />of Organization) <br />n P. Hilary, Director of Estimati <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 23rd day of May 2023 <br />r <br />t <br />otary Pumic <br />My Commission Expires: June 5, 2030 <br />ALISHA KRUEGER <br />ci ` P B�i� * Commission ExP'ues <br />County of Residence: LaPorte =r;' ;,: June 5,2030 <br />=; SEAL Commission Number NP0653544 <br />'o;p' La Porte County <br />