NON-COLLUSION AFFIDAVIT
This affidavit is to be filled out and executed by the bidder; if a corporation makes the bid, then by its properly
executed agent. The name of the individual swearing to the affidavit should always appear on the line marked
"Name of Affidavit." The affidavit's capacity, when a partner or officer of a corporation, should be inserted on
lines marked "Capacity." The affidavit should sign individual name at end not partnership or corporation name,
and swear to said affidavit before a notary public, who must attach his/her seal.
State of '
County of. '
I, being first duly sworn, do hereby state that
(Name of Affidavit)
lam, of
(Capacity) (Name of Firm, Partnership, Corporation)
whose business is
and who resides at
and that
(Give names of all persons, firms, or corporation interested in the bid)
is/are the only person(s) with me/us in the profits of the herein contained contract; that the contract is made
without any connection or interest in the profits thereof with any persons making any bid or proposal for said
work; that the said contract is on my/our part, in all respects fair and without collusion or fraud, and also that no
members of the Board of Trustees, head of any department or bureau, or employee therein, or any employee
of the Authority, is directly or indirectly interested therein.
SIGNATURE OF AFFIDAVIT
SWORN TO BEFORE ME THIS DAY OF , 20
NOTARY PUBLIC
SEAL
MY COMMISSION EXPIRES
35
