____________________________ representing _______________________________
who, being by me first duly sworn deposed and said that he has read this affidavit
and does hereby agree under oath and certify:
(1) Affiant employed no person, corporation, firm, association, or other organization,
either directly or indirectly, to secure the public contract under which he received
payment, other than persons regularly employed by the affiant whose services in connection
with the construction, alteration or demolition of the public building or project
or in securing the public contract wherein the regular course of their duties for
affiant; and
(2) That no part of the contract price received by affiant was paid or will be paid
to any person, corporation, firm, association, or other organization for soliciting
the contract, other than the payment of their normal compensation to persons regularly
employed by the affiant whose services in connection with the construction, alteration
or demolition of the public building or project were in the regular course of their
duties for affiant.
That the architect or engineer, or representative thereof, does not own a substantial
financial interest, either directly or indirectly, in any corporation, firm, partnership,
or other organization which supplies materials for the construction of a public building
or project when the architect or engineer has performed architectural or engineering
services, either directly or indirectly, in connection with the public building or
project for which the materials are being supplied.
For the purposes of this section, a “substantial financial interest” shall exclude
any interest in stock being traded on the American Stock Exchange or the New York
Stock Exchange.
Whoever violates the provisions of this part shall be guilty of a misdemeanor and
shall be fined not more than $1,000.00 or imprisoned for not more than six months,
or both.
That affiant does hereby state that he has read and agrees to comply with and be subject
to these statutory provisions regarding regulation of closed specifications and exclusive
distribution of materials.
That affiant fully understands that all public works contracts shall be let by contract
to the lowest responsible bidder who has bid according to the contract, plans and
specifications as advertised; and
That affiant acknowledges that he has read and understands Article 3.2.3 of the Instructions
to Bidders, and that the price shown on the bid form is based solely on the Bidding
Documents, including any addenda.
SWORN TO AND SUBSCRIBED before me, this ____ day of _______________, 20____.
__________________________________________
NOTARY PUBLIC