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10 <br />State of North Carolina <br />County of Orange <br />NON-COLLUSION AFFIDAVIT <br />Proposal Request No. 5158 <br />being first duly sworn, deposes and says that: <br />I. He/She is the of ,the proposer that <br />has submitted the attached proposal; <br />2. He/She is fully informed respecting the preparation and contents of the attached proposal and of <br />all pertinent circumstances respecting such proposal; <br />3. Such proposal is genuine and is not a collusive or sham proposal; <br />4. Neither the said proposer nor any of its officers, partners, owners, agents, representatives, <br />employees or parties in interest, including this affiant, has in any way colluded, conspired, <br />connived or agreed, directly or indirectly, with any other proposer firm or Person to submit a <br />collusive or sham proposal in connection with the contract for which the attached proposal has <br />been submitted or to refrain from proposing in connection with such contract, or has in any <br />manner, directly or indirectly sought by agreement or collusion of communication or conference <br />with any other proposer, firm or person to fix the price or prices in the attached proposal or of any <br />other proposers, or to fix any overhead, profit or cost element of the proposal price of the <br />proposal of any other proposer or to secure through collusion, conspiracy, connivance or unlawful <br />agreement any advantage against the County of Orange or any person interested in the proposed <br />contract; and <br />5. The price or prices quoted in the attached proposal are fair and proper and are not tainted by any <br />collusion, conspiracy, connivance or unlawful agreement on the part of the proposer or any of its <br />agents, representatives, owners, employees, or parties in interest, including this affiant. <br />Signature <br />Title <br />Subscribed and Sworn to Before Me, <br />This day of , 20 <br />Notary Public <br />My Commission Expires: <br />