Addendum #1 - Gagarin Drainage - Corrected Non-Collusion Packet - Oct 5

HOLD HARMLESS AGREEMENT

The Contractor named below agrees that it will indemnify and hold harmless the Litchfield Housing Trust and its respective officers, agents and employees from any loss, costs, damages, expenses, judgments and liability whatsoever kind or nature howsoever the same may be caused resulting directly or indirectly by any negligent act or omission of the contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable resulting in bodily injury including sickness and death, personal injury or damage to property directly or indirectly, including the loss of use resulting therefrom as permitted by law, unless and to the extent caused by the Litchfield Housing Trust's negligence or its willful acts.

SUPPLEMENTAL AGREEMENT

The Contractor named below is an independent contractor and neither the Contractor nor its employees nor the Contractor's subcontractors under any circumstances, will be considered servants or agents of the Litchfield Housing Trust and the Trust will be at no time legally responsible for any negligence or other wrong doing by the Contractor, its servants or agents or the Contractor's subcontractors. The Trust will not withhold from the contract payments to the Contractor for any federal or state unemployment taxes, federal or state income taxes, Social Security tax, or any other amounts for benefits to the Contractor. The lump sum or unit charges for the services provided does not represent gross wages and further the Trust will not provide the Contractor any insurance coverage or other benefits, including Workers' Compensation, normally provided by the Trust for its employees.

STATE OF CONNECTICUT )

) ss:

COUNTY OF )

Signed:

Print Name:

Title:

Company:

Address:

Subscribed and sworn to before me on

this day of , 20__.

Notary Public

LITCHFIELD HOUSING TRUST

NONDISCRIMINATION CERTIFICATION

Representation by Individual

Written representation that complies with the nondiscrimination agreements and warranties under the Connecticut General Statutes ss/ss 4a-60(a)(1) and 4a-60a(a)(1) as amended.

Instructions:

For use by an individual who is not an entity (corporation, limited liability company, or partnership) when entering into any contract type with the Litchfield Housing Trust, regardless of contract value. Submit to the awarding agency prior to contract execution.

Representation of an Individual:

I, _____________________________, of _____________________________________,

Signatory Business Address

Represent that I will comply with the nondiscrimination agreements and warranties of Connecticut General Statutes ss/ss 4a-60(a)(1) and 4a-60 (a) (1) as amended.

_______________________________ ________________________

Signatory Date

____________________________________

Printed Name

LITCHFIELD HOUSING TRUST

NONDISCRIMINATION CERTIFICATION

Representation by Entity

Written representation that complies with the nondiscrimination agreements and warranties under the Connecticut General Statutes ss/ss 4a-60(a)(1) and 4a-60a(a)(1) as amended.

Instructions:

For use by an entity (corporation, limited liability company, or partnership) when entering into any contract type with the Litchfield Housing Trust, regardless of contract value. Submit to the awarding agency prior to contract execution.

Representation of an Entity:

I, ___________________________, _________________, of ____________________,

Authorized Signatory Title Name of Entity

An entity duly formed and existing under the laws of ____________________________,

Name State of Commonwealth

Represent that I am authorized to execute and deliver this representation on behalf of

_____________________________ and that ____________________________ has a

Name of Entity Name of Entity

Policy in place that complies with the nondiscrimination agreements and warranties of Connecticut General Statutes ss/ss 4a-60(a)(1) and 4a-60 (a) (1) as amended.

_______________________________ ________________________

Authorized Signatory Date

____________________________________

Printed Name

NON-COLLUSION AFFIDAVIT

(This affidavit must be signed and sworn to by the person signing bid)

AFFIDAVIT FOR INDIVIDUAL BIDDER

STATE OF____________________________________

COUNTRY OF ________________________________

______________________________ Being first duly sworn, deposes and says:

(Persons Name)

That they are the person who is the Bidder submitting the accompanying bid for Litchfield Housing Trust Project, and that they, having read, understood, and agreed to all the terms and provisions thereof, signed this affidavit; and the accompanying bid; and that such bid is genuine and not a sham or collusive or made in the interest or on behalf of any person not therein named; and that said Bidder has not directly or indirectly, induced or solicited any other Bidder to put in a sham bid, or any other person, firm or corporation to refrain from bidding and that said Bidder has not in any manner sought by collusion to secure said Bidder any advantage over any other Bidder; and that said Bidder has not otherwise taken any action in restraint of free competitive bidding in connection with the subject bid.

Signed and sworn to before me this ____________day of __________________, 20___

________________________________My Commission expires_________________________

Notary Public

(Seal)

________________________________________

(Signature of named individual)

NON-COLLUSION AFFIDAVIT

(This affidavit must be signed and sworn to by the person signing bid)

AFFIDAVIT FOR CO-PARTNERSHIP BIDDER

STATE OF____________________________________

COUNTRY OF ________________________________

____________________________________________________________________________

(Persons Names)

Each being first duly sworn, each deposes and each for themselves says: That they are a member of and that the persons listed above collectively compose the co-partnership firm designated as

________________________________________________who is the Bidder submitting the

(Firm Name)

accompanying bid for Litchfield Housing Trust Project, and that they, being duly authorized, signed this affidavit on behalf of said Bidder; and that such bid is genuine and not a sham or collusive or made in the interest or on behalf of any person not therein named; and that said Bidder has not directly or indirectly, induced or solicited any other Bidder to put in a sham bid, or any other person, firm or corporation to refrain from bidding and that said Bidder has not in any manner sought by collusion to secure said Bidder any advantage over any other Bidder; and that said Bidder has not otherwise taken any action in restraint of free competitive bidding in connection with the subject bid.

Signed and sworn to before me this ____________day of __________________, 20__

________________________________My Commission expires_________________________

Notary Public

(Seal)

Signatures of Named Principals:

________________________________________

________________________________________

________________________________________

NON-COLLUSION AFFIDAVIT

(This affidavit must be signed and sworn to by the person signing bid)

AFFIDAVIT FOR CORPORATION BIDDER

STATE OF____________________________________

COUNTRY OF ________________________________

______________________________ Being first duly sworn, deposes and says:

(Persons Name)

That they are the _____________________________________________of the corporation who

(Official Title of Cooperate Officer or Agent)

Is the Bidder submitting the accompanying bid for Litchfield Housing Trust Project, and that they, being duly authorized, signed this affidavit on behalf of said Bidder; and that such bid is genuine and not a sham or collusive or made in the interest or on behalf of any person not therein named; and that said Bidder has not directly or indirectly, induced or solicited any other Bidder to put in a sham bid, or any other person, firm or corporation to refrain from bidding and that said Bidder has not in any manner sought by collusion to secure said Bidder any advantage over any other Bidder; and that said Bidder has not otherwise taken any action in restraint of free competitive bidding in connection with the subject bid.

Signed and sworn to before me this ____________day of __________________, 20__

________________________________My Commission expires_________________________

Notary Public

(Seal)

________________________________________

(Signature of Cooperate Officer or Agent)