293-22 Exhibit A.pdf

Article 3 .05 No11-Collusio11 Affidavit SS. County of t~l II:>)) ll?..S E- 1-- J, t=u.5-epe. i!.wlia,,,sj:..i of the Township of l-cmo. V;;.LLE-'f , in the County of tV\O'<'f'I s and the State of ~·ew '=i'-ersef , of full age being duly sworn according to law, on !11:1 oath depose and say that: 1am tll<!.ffe Pres tD"" I of the firm of f!.&L,AJ,.LG- IJ)l<>V PaJ!~~~ bidder making the proposal for the above named project, and that I executed the said proposal for the above named project, and that I executed the said proposal with full authority to do so; that said bidder has not, directly or indirectly, entered into any agreement, participation in any collusion or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this Affidavit are true and correct, and made with full knowledge that the Township of West Orange, New Jersey relies upon the truth of the statements contained in said proposal and in the statements contained in the affidavit in awarding the contract for the said project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such a contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by '?;:L14UG- lJtro &.OuJ:, LLC. (N.J.S.A. 52:34-15). Name of Contractor 'i2,t;,UA-(,.L& 1i.,'t:OD trcJllJ{..f.s, kc a? nd sworn before me on this ___J_6 __u._J..-1,/~-----20 I 8. ___ day of_-:f My commission expires: r'1°"¥ 7'; :?L?/9 Note to Notarv:· When completing this form, all notaries must: 1- Indicate date. 2. Indicate State. 3. Sign Name. 4. Affix name by Printing it, typing it, using a rubber stamp, using an impression sea! or using a mechanical stamp. NOTE: The person who signed the proposalformfi'om the respondent

gn Name. 4. Affix name by Printing it, typing it, using a rubber stamp, using an impression sea! or using a mechanical stamp. NOTE: The person who signed the proposalformfi'om the respondent shoztld sign this form also. AIDAN. VEGA NOTARYP/Ji3UC OF NEW .'ERSEY ;k/ Commlss!C41Expi!il1!5/4/2019 39