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DocuSign Envelope ID: D442B3A4-5DOF-49D2-ABA8-60AB45788486 <br /> INON-COLLUSION AFFIDAVIT Proposal Request No.367-005307 <br /> State of North Carolina <br /> Orange County <br /> v <br /> of individual),being first duty sworn,deposes <br /> and says that: <br /> A A <br /> He/Sheisthc "A�� vjvz' - X (title}of L I- <br /> (company name),the proposer that has submitted the attached proposal; <br /> He/She is fully informed respecting the preparation and contents of the attached proposal and of all <br /> 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 panics in interest, including this affiant, has in any way colluded, conspired, connived or <br /> agreed, directly or indirectly, with any other proposer firm or person to submit a collusive or sham <br /> proposal in connection with the contract for which the attached proposal has been submitted or to refrain <br /> from proposing in connection with such contract, or has in any manner, directly or indirectly sought by <br /> agreement or collusion of communication or conference with any other proposer, firm,or person to fix.the <br /> price or prices in the attached proposal or of any other proposers, or to fix any overhead, profit or cost <br /> element of the proposal price of the proposal of any other proposer or to secure through collusion, <br /> conspiracy, connivance or unlawful agreement any advantage against Orange County or any person <br /> interested in the proposed contract; and <br /> 5. The fees provided 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, <br /> representatives,owners,employees.or parties in interest,including this affiant. <br /> S, <br /> Seal <br /> if Corporation <br /> Title <br /> Date: <br /> This form must be notarized <br /> SLq3SCRTBED AND SWORN TO BEFORE IME, <br /> This 'OS —day of C—f. 120 <br /> Notary PublicA�e-' <br /> S SA <br /> My Commissi on Expires: C)C le Co <br /> Notary P <br /> Onb <br /> S Q COU'Irp ur g <br /> z ,,rn lc, rn. <br /> CA R <br />