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AFFIDAVIT AND INFORMATION REQUIRED OF BIDDERS <br />Affidavit of Non -Collusion: <br />I hereby swear (or affirm) under the penalty for perjury: <br />(1) That I am the bidder (if the bidder is an individual), a partner in the bidder (if the bidder is a <br />partnership), or an officer or employee of the bidding corporation having authority to sign on its <br />behalf (if the bidder is a corporation). <br />(2) That the attached bid or bids have been arrived at by the bidder independently, and have been <br />submitted without collusion with, and without any agreement, understanding, or planned common <br />course of action with, any other vendor of materials, supplies, equipment or services described in <br />the invitation to bid, designed to limit independent bidding or competition; <br />(3) That the contents of the bid or bids have not been communicated by the bidder or its surety on <br />any bond furnished with the bid or bids, and will not be communicated to any such person prior to <br />the official opening of the bid or bids; and <br />(4) That I have fully informed myself regarding the accuracy of the statements made in this affidavit. <br />v✓ JQ <br />Subscribed�Sc-and sworn to before me this <br />t day of 0C-4ober 201LI <br />Signed <br />Firm Name Ct4 T'iGwit =ac. <br />LISA PELLETIER <br />NOTARY PUBLIC • MINNESOTA <br />MY COMMISSION EXPIRES 01/31115 <br />Notary Public <br />My commission expires: ,I 31 20 itS <br />Bidder's E.I. Number: <br />(Number used on employer's quarterly federal tax return, U.S. Treasury Department Form 941): <br />0S34u,w <br />Fair Trade Items: <br />List below each item upon which a bid is made, the price of which is affected by a resale price <br />maintenance or "fair trade" contract between the bidder and the person or firm supplying the item to the <br />bidder. (Use reverse side if necessary.) <br />2014 SURFACE WATER MANAGEMENT PROJECT <br />CITY OF LINO LAKES, MINNESOTA <br />WSB PROJECT NO. 2029-72 <br />AFFIDAVIT <br />