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State of <br />County of <br />NONCOLLUSION AFFIDAVIT OF PRIME BIDDER <br />(Name/s) <br />being first duly sworn, disposes and says that: <br />1. They are of the Bidder that <br />(Title) (Name of Company) <br />has submitted the attached bid; <br />2. He is fully informed respecting the preparation and contents of the attached bid and of all pertinent <br />circumstances respecting such Bid; <br />3, Such Bid is genuine and is not a collusive or sham Bid; <br />4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or <br />parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or <br />indirectly with any other bidder, firm or person to submit a collusive or sham Bid in connection with the <br />contract for which the attached bid has been submitted or to refrain from bidding in connection with such <br />Contract or has in any manner, directly or indirectly, sought by agreement or collusion or communication or <br />conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other <br />Bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage <br />against the City/County or any person interested in the proposed Contract; and <br />5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, <br />conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, <br />representatives, owners, employees, or parties in interest, including this affiant. <br />(Signed) <br />(Title) <br />STATE OF FLORIDA } <br />COUNTY OF INDIAN RIVER ' }SS: <br />The foregoing instrument was acknowledged before me this <br />(Date) <br />who is personally known to me or who has produced <br />by: <br />as identification and who did (did not) take an oath. <br />Commission No. <br />Notary (print & sign name) <br />P-62 Noncollusion Affidavit <br />F:\Engineering\Capital Projects\0216-12th Street Between 16th Avenue and 11th Place\0216 Federal Contract Provisions.docar rzow <br />3:06:25 PM <br />