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

_______________________________

Sworn to and subscribed before me by on ___________________.

______________________________

Notary Public

My commission expires: