NON-COLLUSION_AFFIDAVIT.pdf

NON-COLLUSION AFFIDAVIT

NOTE: Each proposer shall furnish this affidavit, properly executed and containing all required information, with his/her proposal. IF YOU FAIL TO COMPLY, YOUR PROPOSAL WILL NOT BE CONSIDERED.

State of _____________________________________

County of ____________________________________

__________________________________ SS: ____________________ being first duly sworn deposes and says:

Individual only: That he is an individual doing business under the name of at in the City of

State of .

Partnership only: That he is duly authorized representative of a partnership doing business under the name of in the City of

State of .

Corporation only: That he is duly authorized, qualified and acting of , a corporation organized and existing under the laws of the State of , and that said partnership or said corporation is filling herewith a proposal to the Transit

Authority of Lexington-Fayette Urban County Government in conformity with the foregoing Scope of Work:

Individual only: Affiant further says that the following is a complete and accurate list of the names and addresses of all persons interested in said proposed contract: Affiant further says that he is represented by the following attorney (s):

.and is also represented by the following resident agents in the City of Lexington:

Partnership only: Affiant further says that the following is a complete and accurate list of the names and addresses of the members of said partnership:

Affiant further says that said partnership is represented by the following attorney(s): and is also represented by the following resident agents in the City of Lexington:

Corporation only: Affiant further says that the following is a complete and accurate list of the officers, directors and attorneys of said corporations:

President: ____________________________________________

Directors:_____________________________________________

Vice President: ________________________________________

Secretary:_____________________________________________

Treasurer:_____________________________________________

Local Manager of Statutory Agent:_________________________

Attorneys:_____________________________________________

And that the following officers are duly authorized to execute contracts on behalf of said corporation:_____________________

Affiant further says that the proposal filed herewith is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation; that such proposal is genuine and not collusion or sham; that said proposer has not, directly or indirectly, induced or solicited any other proposer to put in a false or sham proposal, and has not directly or indirectly colluded conspired, connived or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that said proper has not in any manner, directly or indirectly, sought by agreement, communication or conference with other proposer , or to fix any overhead, profit, or cost element of such proposal price or that any other proposer or to secure any advantage against the Transit Authority of

Lexington-Fayette Urban County Government, or anyone interested in the proposed contract; that all statements contained in such proposal are true; that said proposer has not directly, or indirectly , submitted his price or any break-down thereof or the contents thereof, or divulged information or data relative thereto, or paid or agreed to pay, directly or indirectly, any money or other valuable consideration , assistance or aid rendered or to be rendered in procuring or attempting to procure the contract above referred to, to any corporation, partnership, company, association, organization, or to any member or agent thereof, or to any other individual, except such persons as herein above disclosed to have a partnership or other financial interest with said proposer will not pay or agree to pay, directly or indirectly, any money or other valuable consideration to any corporation, partnership, company association, organization or to assistance in securing contract above referred to in the event the same is awarded to:

Further affiant saith not.

(Sign Here)

Sworn to before me and subscribed in the presence this ______day of____________________, 20____.

Notary Public: _____________________________________________

My Commission Expires:____________________________________