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Affidavit Of Non-Collusion

STATE OF )

COUNTY OF )

[Name] being duly sworn or affirmed to tell the truth, deposes, stating:

I am the ______________ of _______________. I have acted as a supervisory officer of in the preparation of a bid for ____________, [Date] and am familiar with the preparation of the bid.

The bid was prepared in good faith and was prepared solely by consideration of business exigencies. The bid was no in way collusive with other bidders herein, or with any other person, firm or entity and was prepared solely by _______________ with information derived from necessary material suppliers or other sub-contractors.

Is not a party to any agreement to cause others to refrain from bidding, to set the amount of the bid or any part thereof, or to secure any advantage against ______________________.

The prices and each element of the prices were established fairly and were made in conformity with any applicable laws or regulations related to such bids.

This affidavit is made to induce to consider or to accept the bid made by herein, and shall rely upon the factual representations herein in determining whether to accept or reject the bid.

FURTHER AFFIANT SAYETH NAUGHT

_______________________________

*** If Required By FederaL or State Law ***

This Section for Notary:

ACKNOWLEDGMENT

State of _________

County of ________ [COUNTY]

On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

Signature ________
Notary

My commission expires: _____

(Seal)