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CITY OF F;VERE.l T PUBLIC'WORKS <br /> SPECIAL,PROVISIONS <br /> DOCUMENT 00 45 19_NONCOLLUSION AFFIDAVIT <br /> GENERAL <br /> A. Bidder shall fill out affidavit below, notarize,and include with Bid. <br /> STATE OF WASHINGTON <br /> COUNTY OF Cowlitz <br /> r . <br /> .Qn( 1 SvklootrSt G ,being first daily sworn,on his/her oath says that the Bid <br /> above sot matted is a emit ne and nota sham of collusive bid,or made in the interest to on behalf of <br /> ' <br /> any person not therein named, and he farther says that the Bidder has not directly or indirectly induced <br /> or solicited any Bidder on the above Work or supplies to put in a sham bid, or any person OT <br /> corporation to refrain from bidding; and that said Bidder has not in any manner sought by collusion to <br /> ' secure an advantage over any other Bidder or Bidders. <br /> Firm Name -gq Sub a.s Authorized Signature, Se.-c/(e <br /> SUBSCRIBED and SWORN to before mc this 11L.thy of. July _ _ 2017. <br /> _ <br /> o <br /> OTA: Y PUBLIC it and for the State of WasItington, residing at Woodland, WA. <br /> my commission expires,-. July 28th, 2018 <br /> OF D 'NT 0045 l `c���fuaaatrr:, rr <br /> lM. l C!C't Wit: •`�y\ TRUMA <br /> �,.7J — <br /> *f :: 2 <br /> •s' WAS14 <br /> 111 inotP` <br /> Portal JReplacement June 2017 <br /> ' WO#LT3602 00 45 19 M l <br />