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Randolph County                                                                                                                     Bid 07-1001

Due Date:  Thursday, October 25, 2007, 3:00P.M.                                                         EMS Ambulances

_____________________________________________________________________________________

STATE OF NORTH CAROLINA

RANDOLPH COUNTY

________________________________________________, being first duly sworn deposes and affirms that:

1.

He is the ___________________ of ________________________________________ the bidder that has submitted the attached bid;

2.

He is fully informed respecting the preparation and contents of the attached bid and of all pertinent circumstances respecting such bid;

3.

Such bid is genuine and is not a collusive or sham bid;

4.

Neither the said bidder, nor any of its officers, partners, owners agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other bidder, firm or person to submit a collusive or sham bid in connection with the contract for which the attached bid has been submitted or to refrain from bidding in connection with such contract, or has in any manner, directly or indirectly sought by agreement or collusion or communication or conference with any other bidder, firm or person to fix any overhead, profit, or cost element of the bid price of any other bidder to secure through collusion, conspiracy, connivance or unlawful agreement any advantage against Randolph County, or any person interested in the proposed contract; and

5.

The price or prices quoted in the attached bid are fair and proper and are not contained by any collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or any of its agents, representatives, owners, employees, or parties, in interest, including this affiant.

____________________________________________   Title

_______________________________________________   Signature

____________________________________________   Date

____________________________________________   Phone

____________________________________________   Email

(SEAL)

Subscribed and sworn to before me,                                                                                 

this the ______ day of ________________, 20____.

Notary Public _______________________________

County of _____________ , NC    My Commission expires _______________________

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