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Mounds View <br />Request for Proposals Residential Solid Waste and Recycling Services <br /> Page F-1 <br />MU210\313\945437.v5 <br />Affidavit of Non-Collusion: <br /> <br />I hereby swear (or affirm) under the penalty of perjury: <br /> <br />1. That I am the Proposer (if the Proposer is an individual), a partner with the Proposer (if the Proposer <br />is a partnership), or an officer or employee of the proposing corporation having authority to sign on its <br />behalf (if the Proposer is a corporation); <br /> <br />2. That the attached proposal or proposals have been arrived at by the Proposer, independently, and <br />have been submitted without collusion with, and without any agreement, understanding, or planned <br />common course of action with, any other vendor of materials, supplies, equipment, or services described in <br />the request for proposals, designed to limit independent proposing or competition; <br /> <br />3. That the contents of the proposal or proposals have not been communicated by the Proposer or its <br />employees or agents to any person not an employee or agent of the Proposer or its surety on any bond <br />furnished with the proposal or official reviewing the proposal or proposals; and <br /> <br />4. That I have fully informed myself regarding the accuracy of the statements made in this affidavit. <br /> <br /> <br />Signed: <br /> <br />Firm Name: <br /> <br /> <br /> <br />Subscribed and sworn to before me this <br /> day of , 20___ <br /> <br /> <br /> <br />Notary Public <br />My Commission expires , 20 <br /> <br /> <br /> <br />