HomeMy WebLinkAboutNON-COLLUSION AFFIDAVIT 2021NON-COLLUSION AFFIDAVIT
Contract/Bid No :
State of: ________________________:
: ss
County of: ______________________:
I state that I am ____________ of __________________________________________________
(Title) (Firm)
and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors,
and officers. I am the person responsible in my firm for the price(s) and the amount of this bid.
I state that:
1. The price(s) and amount of this bid have been arrived at independently and without
consultation, communication or agreement with any other contractor, bidder or potential
bidder.
2. Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor
approximate amount of this bid, have been disclosed to any other firm or person who is a
bidder or potential bidder, and they will not be disclosed before bid opening .
3. No attempt has been made or will be made to induce any firm or person to refrain from
bidding on this contract, or to submit a bid higher than this bid, or to submit any
intentionally high or noncompetitive bid or other form of complementary bid.
4. The bid of my firm is made in good faith and not pursuant to any agreement or discussion
with, or inducement from, any firm or person to submit a complementary or other
noncompetitive bid.
5. ________________________________, its affiliates, subsidiaries, officers, directors, and
(Firm)
employees are not currently under investigation by any governmental agency and have not
in the last four years been convicted or found liable for any act prohibited by State or Federal
Law in any jurisdiction, involving conspiracy or collusion with re spect to bidding on any
public contract, except as follows:
6. ___________________________ has or has not (circle one) been convicted or found liable
for any act prohibited by State or Federal Law in any jurisdiction involving conspiracy or
collusion with respect to bidding on any public contract within the last three (3) years.
I state that ____________________________________ understands
(Firm)
acknowledges that the above responsibilities are material and important,
and will be relied on by the Owner in awarding the contract(s) for which
this Bid is submitted. I understand and my firm understands that any
misstatement in this affidavit is and shall be treated as fraudulent
concealment from the Owner of the true facts relating to the submission
of bids for this contract.
______________________________________
Name
______________________________________
Company Position
SWORN TO AND SUBSCRIBED
BEFORE ME THIS ___________
DAY OF _________, 20 _______.
_______________________________________
Notary Public
My Commission Expires: