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Brown County, Indiana Board of County Commissioners P.O. Box 37 Nashville, IN 47448 NON-COLLUSION AFFIDAVIT STATE OF INDIANA ) ) SS: COUNTY ) The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone relating to the attached bid or price quotation nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is make without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale. Bidder (Firm) Signature of Bidder or Agent Subscribed and sworn to before me this day of 2021 My Commission Expires: Notary Public County of Residence: