STATE OF LOUISIANA
PARISH OF _______________________
Before me, the undersigned authority, duly commissioned and qualified within and for the State and Parish aforesaid, personally came and appeared
____________________________ 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____.