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State of North Carolina <br />County of Rockingham <br />1 1C- C �- , being first duly sworn, deposes and says that: <br />1. He /She is the F`' of --- <br />offeror that has submitted the attached proposal; <br />2. He /She is fully informed respecting the preparation and contents of the attached proposal <br />and of all pertinent circumstances respecting such proposal; <br />3. Such proposal is genuine and is not a collusive or sham proposal; <br />4. Neither the said offeror nor any of its officers, partners, owners agents, representatives, <br />employees or parties of interest, including this affidavit, has in any way colluded, <br />conspired, connived or agreed, directly or indirectly, with any other offeror, firm or <br />person to submit a collusive or sham proposal in connection with the contract for which <br />the attached proposal has been submitted or to refrain from bidding in connection with <br />such contract, or has in any manner, directly or indirectly, sought by agreement or <br />collusion or communication or conference with any other offeror, firm or person to fix <br />the price or prices in the attached proposal or of any other offeror, or to fix any overhead, <br />profit or cost element of the proposal price of any other offeror or to secure through <br />collusion, conspiracy, connivance or unlawful agreement any advantage against the <br />County of Rockingham or any person interested in the proposed contract; and <br />5. The price or prices quoted in the attached proposal are fair and proper and are not tainted <br />by any collusion, conspiracy, connivance or unlawful agreement on the part of the offeror <br />or any of its agents, representatives, owners, employees, or parties in interest, including <br />this affidavit. <br />ror <br />Subs6db24-and sworn before me, <br />This day of 5,� Ve-� _ , 20 ll <br />Notary Public <br />My Commission Expires <br />.Date <br />a <br />Y-�V'1-)C'-A- b "A na-- <br />TITLE <br />53 <br />Attachment number 1 <br />F -5 Page 152 <br />