|
NON-COLLUSION AFFIDAVIT
<br />STATE OF OHIO )
<br />SS
<br />h~ h-- i ~ COUNTY )
<br />Bid identification .~,~~~ ~~ ~ (Z.r25~-~ Un~lCs ~ dCe~ ~~?~' T Lc tZ r~~~~~ ~-~~ r r~~~-
<br />Contractor, ? 1... W : l-~o N Cd ., ~ N c • DB Q l,-l ~ l~-d K r"(-u s .' ~ _
<br />being first duly sworn, deposes and says that he is
<br />~~'~~ (~S ~ oe~~ (sole owner, a partner, president, secretary,
<br />etc.) of ~ L ~ ~` ~ ~o ~, ~o ~~cc ~~ A ~ ; ~~o~ MA~,S %c~
<br />, the party making the foregoing bid; that such bid is not
<br />made in the interest of or on behalf of any undisclosed person, partnership, company, association,
<br />organization, or corporation; that such bid is genuine -and not collusive or sham; that said bidder has not
<br />directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not
<br />directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a
<br />sham bid, or that anyone shall refrain from bidding; that said bidder has not in any manner, directly or
<br />indirectly, sought by agreement, communication or conference with anyone to fix the bid price of said
<br />bidder or of any other bidder, or to fix any overhead, profit, or cost element, of such bid price, or, of that
<br />of any other bidder, or to secure any advantage against the public body awarding the contract or anyone
<br />interested in the proposed contract; that all statements contained in such bid are true; and, further that said
<br />bidder has not, directly or indirectly, submitted his bid price or any breakdown thereof, or the contents
<br />thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection
<br />therewith, to any corporation,.parmership, company, association, organization, bid depository, or to any
<br />member or agent thereof, or to any other individual except to such person or persons as have a partnership
<br />or other financial interest with said bidder in his general business.
<br />`~.
<br />~~''~•
<br />SIGNED
<br />C --~'/'
<br />TITLE V ~`C~.P f ~P S i ~2 w~
<br />Subscribed and sworn to me before this
<br />~~~~ ~
<br />~
<br />~~ !
<br />~< (SEA p MACKEF
<br />NOTARY `
<br />~`~"'r "' ,
<br />STATE Of OHIO
<br />~`r ; MY COMMISSION EXPIRES: 09/20/2014
<br />P 4~n~ p ~;
<br />day of ~'~ .~ ,_ ' ~~~„~' 20
<br />Notary 1?r;~ is
<br />NA-1
<br />
|