October 15, 2012 - City of Laredo

Proposal Page 2 of 9
AFFIDAVIT
Form,of Non-Collusive Affidavit
STATE OF TEXAS {}
COUNTY OF WEBB {)
k\is 7. ~OYIU~CCL - &ftmc&
being first duly sworn, deposes and says
Thatheis C-t-?cn~va\ hflanaa-cil.
(a Partner of Officer of the fMn of, etc.)
the party making the foregoing proposal or bid, that such proposal or bid is genuine and not
collusive or sham; that said Bidder has not colluded, conspired, connived or agreed, directly or
indirectly, with any Bidder or Person, to put in a sham bid or to refrain from bidding, and has not
in any manner, directly or indirectly, sought by agreement
B
or collusion, or communication or
conference, with any person, to fix the bid price or affi or of any other Bidder or to fix any
overhead, profit or cost element of said bid price, or oft of any other Bidder, or to secure any
advantage against the City of Laredo or any person inte sted in the proposed Contract; and that
all statements in said proposal or bid are true.
signatde%f
Subscribed and sworn before me this 4% day of
My Commission expires
OL.
z-a 42.014
Bidder, if the Bidder is an individual
Partner, if the Bidder is a Partnership
Officer, if the Bidder is a Corporation
xotary Public
. . T.:;
Division A
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