SRV Construction Company 5/1/2018

I ICITY OF EVERETT SPECIAL PROVISIONS I NON-COLLUSION AFFIDAVIT I STATE OF WASHINGTON ) NON-COLLUSION AFFIDAVIT )ss COUNTY OF SNOHOMISH ) IKrysta Verbarendse , beingduly first sworn, on his oath says that the Bid above submitted is a genuine and not a sham of collusive bid, or made in the I interest or on behalf of any person not therein named; and he further says that the Bidder has not directly or indirectly induced or solicited any Bidder on the above Work or supplies to put in a sham bid, or any person or corporation to refrain from bidding; and that said Bidder has not in any manner sought by collusion to secure an advantage over any other Bidder or Bidders. NOTICE TO ALL BIDDERS To report bid rigging activities call: I1-800-424-9071 The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday through I Friday, 8:00 a.m. to 5:00 p.m., Eastern Time. Anyone with knowledge of possible bid rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such activities. I The"hotline" is part of USDOT's continuing effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected. ONS�RUCT/O�/ I ...clA.) /(j(AA., (k--. - SRV Construction, Inc. ��: CORpORgTE•:�' Signature CONTRACTOR NAME SEAL i Subscribed and sworn to before this 20 day of March ,.2-018. ' 1991 / 14,gSHI...... I /i/-) , z: / ' z 01,k 11 IAI 11l y /1 ( l i �; �\ r,0• /i I� afy Public in and for the�'rState oj7Washington N: residing at Island County NOTARY � 0 *. PUBLIC ;�z . II -.A.. • I,///...V I - s\A�%•``♦ Water Main Replacement"Q" Division P—PROPOSAL February 9, 2018 I -Evergreen Way Rebid Work Order No.—UP3612 SP—25 a35 Non-Collusion Affidavit r ed to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.corn-Always Verify Scale