AffidavitOfNoncollusion_Offeror_(01_2014_GKM).doc

OFFEROR’S and INDIVIDUALS’ AFFIDAVIT OF NONCOLLUSION

(This affidavit to be executed in accordance with O.C.G.A. § 36-91-21(e))

STATE OF ______________________

COUNTY OF ____________________

COMES NOW, _________________________________________________________ (“Offeror”), [name of Offeror] appearing by and through __________________________________ , it’s _________________________

[insert name of individual with

[title] authority to bind Offeror]

(averring both individually and in his or her representative capacity on behalf of Offeror) (the “Individual And

Representative Affiant”), and _____________________________________________________________

[in these blanks insert the names of all those required to give the oath under O.C.G.A. § 36-91-21(e)]

(collectively, the “Individual Affiants”), and each of the Individual And Representative Affiant and the Individual

Affiants, after first being duly sworn, deposes and says that:

1. He, she or it, as applicable, has not directly or indirectly violated subsection (d) of the Official Code of Georgia Annotated Section 36-91-21, which subsection provides as follows:

(d) Whenever a public works construction contract for any governmental entity subject to the requirements of this chapter is to be let out by competitive sealed bid or proposal, no person, by himself or herself or otherwise, shall prevent or attempt to prevent competition in such bidding or proposals by any means whatever. No person who desires to procure such work for himself or herself or for another shall prevent or endeavor to prevent anyone from making a bid or proposal therefor by any means whatever, nor shall such person so desiring the work cause or induce another to withdraw a bid or proposal for the work.

2. If the Offeror is a partnership, then the Individual And Representative Affiant, together with the

Individual Affiants, constitute all of the partners and any officer, agent or other person who may have represented or acted for them in bidding or proposing for or procuring the contract for the Walker County Board of Education Project for Chattanooga Valley Elementary School Reroof Project (the “Project”).

3. If the Offeror is a corporation or other entity, then the Individual And Representative Affiant, together with the Individual Affiants, constitute all officers, agents, or other persons who may have acted for or represented the corporation or other entity in bidding for or procuring the contract for the Project.

Further, the Individual And Representative Affiant and the Individual Affiants sayeth not.

This _______ day of _______________, 2____

[insert name of Offeror] and

[insert name of Individual And Representative Affiant]

By: ___________________________________, both individually and on behalf of Offeror as its

[signature]

[insert title]

Individual Affiants’ signatures and names:

x_____________________________________ x____________________________________

Name:

x_____________________________________

Sworn to and subscribed before me this ___ day of _______________, 2____.

Notary Public: _____________________ My commission expires: __/__/__.

(SEAL)

12.2008

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01.2014