Orange County NC Website
Browse       Search
i2/21l99 <br />EXECUT#ON OF BID, NONCOLLUS#ON AFF#DAY#T AND DEBARMENT CERTIF#CAT#ON <br />The person executing the bid, on behalf of ttte Bidder, being duly sworn, solemnly swears (or affirms) that <br />neither he, nor any offrcial, agent or empbyee of the bidder has entered into any agreement, participated <br />in any coilusian, or otherwise taken any action which is in restraint of free competitive bidding in <br />connection with this bid, and that the Bidder intends to do the work with its own banafide empbyees or <br />subcontractors and is not bidding for the benefit of another contractor. <br />In addition, execution of this bid in the proper manner also constitutes the Bklder's certification of "States° <br />under penalty of perjury under the laws of the United States in accordance with the Debarment <br />Certifx;ation included elsewhere in the proposal form, provided that the Debarment Certification also <br />includes any required statements concerning exceptions that are applicable. <br />SIGNATURE OF CONTRACTOR <br />(!f a corporation uses this sheet) <br />(Print full name of <br />ueie[e -nappropnate tme <br />Print Sufner's Name <br />l.J~eltste inappropriate title - <br />~a~ v mss' G• tit ~ u,~-,~+~ <br />Print Signer's Name <br />CORPORATE SEAL <br />NOTE -AFFIDAVIT MUST BE NOTARIZED <br />Sub//scribed and sworn to before me this the <br />V day of ~tl'VG, 20~. <br />C (Si^gnaty~~F rotary Public) <br />of t~rhQ./~' County. <br />State of ~ ~- <br />My Commission Expires: cjtt,/tp ~~~Ol 3 <br />Signature sheet i (Bid) - Corporati~ <br />55 <br />3l~L. ~,~•, . p. <br />~' r ~ ~ U <br />0 •• ~ <br />n~ <br />~r~~i~~d ~.....©v~\\`~~~ <br />