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KITTITAS COUNTY <br />BID PROPOSAL <br />NAME OF FIRM: <br />ADDRESS: <br />TELEPHONE: FAX: <br />FEDERAL I.D. TAX NO. <br />TITLE & NAME OF PERSON PREPARING BID: <br />NON -COLLUSION DECLARATION <br />I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the United States <br />that the following statements are true and correct: <br />1. That the undersigned person(s), firm, association or corporation has (have) not, either directly or <br />indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in <br />restrain of free competitive bidding in connection with the project for which this proposal is submitted. <br />That by signing the signature page of this proposal, I am deemed to have signed and have agreed to the <br />provisions of this declaration. <br />ADDITIONAL ASSURANCE AND CERTIFICATIONS <br />Bidder hereby certifies that he/she will comply with all assurances and certifications issued by Kittitas <br />County, and conform to all applicable state and federal laws. <br />The bidder is hereby advised that by signature of this proposal he/she is deemed to have acknowledged <br />all requirements and signed all certificates contained herein. <br />FIRM NAME <br />Signature of Authorized <br />Type/Print Name: <br />Title: <br />Maintenance Rock 2024 Page 13 <br />