Conference/Public Meeting Agenda/Documents — Packet

Section 3.04 Non-Collusion Affidavit State of Now Jersey SS. County of Yud SON i, N ick las. ene of the Township of. Hl ‘ Ag [ , in the County of Unwiorkin and the State of _V2wt Sty , of full age being duly sworn according to law, on my oath depose and sa’ that: Tam (ZS of the firm of UGe 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_MON €& (N.J.S.A. 52:34-15) Name of Contractor Reliable Wood Aetucts, ue X/ | holo WO (Starplame Here) By: Nicholas Vene Subscribed and sworn before me on this Z ly day of fugust ¥ojdtry Rublic) HOLAR UC OF Re say i My céinmission expires: May $ oS Note to Notarv: When completing the jurat, 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 for the respondent should sign this form also. WARNING: IF YOU FAIL TO FULLY, ACCURATELY, AND COMPLETELY FILL OUT THIS AFFIDAVIT OF NON-COLLUSION, YOUR PROPOSAL SHALL BE REJECTED. io) a