2014-120 Council Resolution - Laserfiche WebLink

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AFFIDAVIT AND INFORMATION REQUIRED OF BIDDERS Affidavit of Non -Collusion: I hereby swear (or affirm) under the penalty for perjury: (1) That I am the bidder (if the bidder is an individual), a partner in the bidder (if the bidder is a partnership), or an officer or employee of the bidding corporation having authority to sign on its behalf (if the bidder is a corporation). (2) That the attached bid or bids have been arrived at by the bidder independently, and have been submitted without collusion with, and without any agreement, understanding, or planned common course of action with, any other vendor of materials, supplies, equipment or services described in the invitation to bid, designed to limit independent bidding or competition; (3) That the contents of the bid or bids have not been communicated by the bidder or its surety on any bond furnished with the bid or bids, and will not be communicated to any such person prior to the official opening of the bid or bids; and (4) That I have fully informed myself regarding the accuracy of the statements made in this affidavit. Subscribed and sworn to before me this 1 day of 0C Ober- , 20 1q uathru cuQ�.o Notary Public My commission expires: , 3k Bidder's El. Number: Signed Firm Name C i3O ri G �.�.t 1 •- . , 20. LISA PELLETIER NOTARY PUBLIC • MINNESOTA MY COMMISSION EXPIRES 01/31/15 (Number used on employer's quarterly federal tax return, U.S. Treasury Department Form 941): L l- 0g3 tAo Fair Trade Items: List below each item upon which a bid is made, the price of which is affected by a resale price maintenance or "fair trade' contract between the bidder and the person or firm supplying the item to the bidder. (Use reverse side if necessary.) 2014 SURFACE WATER MANAGEMENT PROJECT CITY OF LINO LAKES, MINNESOTA WSB PROJECT NO. 2029-72 AFFIDAVIT