Finance Committee - Agenda - 12/26/2017 - P70

Contract Affidavit

I/We declare under penalty of perjury under the laws of the United States and the State of New
Hampshire that, in accordance with the provisions of Title 23 USC, Section 112(c), have not either directly or
indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint

of free competitive bidding in connection with this Proposal,

Dated:

(if'a firm or individual)
Signature of Bidder

By.
Address of Bidder
Names and Addresses of Members of the Firm:
(If a Corporation)
Signature of Bidder
Tule
By

Business Address

Incorporated under the laws of the State of

Names of Officers:

President

Name Address
Secretary

Name Address
Treasurer.

Name Address

SICMAQATEWroposal doc