HomeMy WebLinkAboutScanned on 04/05/2017 at 15:20:17 ' ATTACHMENT C - Ylq'
- TOWN OF SOUTH YF' Y.is70Ry CONNFCf IC DIY
PROPOSER'S NON COLLUSION.AFFIDAVIT FORM
PROPOSAL FOR:
The undersigned proposer,having fully informed hirnselflherselffitself regarding the
' accuracy of the statements rnade herein,certified that:
1) the proposal is genuine;it is not a collusive or sham proposal;
' 2) the proposer developed the proposal independently and submitted it without collusion
with, and without any agreement,understanding,communication or planned common
course of action with,any other person or entity designed to limit independent
' competition;
3) the proposer, its employees and agents have not communicated the contents of the
proposal to any person not an employee or agent of the proposer and will not
' communicate the proposal to any such person prior to the official opening of the
proposal; and
4) no elected or appointed official or other officer or employee of the Town of South
' Windsor is directly or indirectly interested in the proposer's proposal,or in the
supplies,materials,equipment,work or labor which it relates, or in any of the profits
thereof.
' The undersigned proposer further certifies that this affidavit is executed for the purpose of
inducing the Town of South Windsor to consider its proposal and make an award in
' accordance therewith.
TaxSery Capital Services, LLC �Y
' Legal Name of Proposer ignature)
Propose ' epresentative,Duly Authorized
' Roger Blain
Name of Proposer's Authorized Representative
President
Title of Proposer's Authorized Representative
September 27, 2016
Date
' Subscribed and sworn to before me this 2 7 t hday of September 9 2016
' Notary Public
My Commission Expires:
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END OF COLLUSION AFFIDAVIT FORM
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