293-22 Exhibit A.pdf

Article 3.05 Non-Collusion Affidavit State of_____________________ SS. County of___________________ I, __________________ of the Township of ________________________, in the County of __________________ and the State of __________________________, of full age being duly sworn according to law, on my oath depose and say that: I am _____________________ of the firm of _____________________, the 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 _________________________ (N.J.S.A. 52:34-15). Name of Contractor __________________________ __________________________ (Sign Name Here) Subscribed and sworn before me on this ______________ day of _________________________ 2018. _________________________ (Notary Public) My commission expires: ___________________________ Note to Notary: 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 seal or using a mechanical stamp. NOTE: The person who signed the proposal form from the respondent should sign this form also.

ng an impression seal or using a mechanical stamp. NOTE: The person who signed the proposal form from the respondent should sign this form also. 40