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<br /> Disaster Debris Clearance and Removal Services <br />Bid: 5266, Orange County, North Carolina <br />July 29, 2019 Page 40 <br /> <br /> <br /> <br />Non-Collusion Affidavit <br />Proposal Request No.XXXXX <br />State of North Carolina <br />Orange County <br />_________________________________________(name of individual), being first duly sworn, deposes and says that: <br />1. He/She is the ___________________________ (title) of __________________________________ (company <br />name), the proposer that has submitted the attached proposal; <br />2. He/She is fully informed respecting the preparation and contents of the attached proposal and of all pertinent <br />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, employees or parties in <br />interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with <br />any other proposer firm or Person to submit a collusive or sham proposal in connection with the contract for <br />which the attached proposal has been submitted or to refrain from proposing in connection with such contract, or <br />has in any manner, directly or indirectly sought by agreement or collusion of communication or conference with <br />any other proposer, firm or person to fix the price or prices in the attached proposal or of any other proposers, or <br />to fix any overhead, profit or cost element of the proposal price of the proposal of any other proposer or to secure <br />through collusion, conspiracy, connivance or unlawful agreement any advantage against the Town or any person <br />interested in the proposed contract; and <br />5. The price or prices quoted in the attached proposal are fair and proper and are not tainted by any collusion, <br />conspiracy, connivance or unlawful agreement on the part of the proposer or any of its agents, representatives, <br />owners, employees, or parties in interest, including this affiant. <br /> <br /> __________________________________ <br /> Signature <br /> Seal <br /> ___________________________________ if <br /> Title Corporation <br /> <br /> Date: ______________________________ <br /> <br />This form must be notarized <br />SUBSCRIBED AND SWORN TO BEFORE ME, <br />This ______ day of ___________________, 2019 <br />Notary Public _____________________________ <br />My Commission Expires: ____________________ <br />DocuSign Envelope ID: 5FA4B1AC-B897-4C32-A1E4-4B4A8885A341