00 45 19 Non Collusion Affidavit.pdf
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- Solicitation number
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- Lancaster County, Pennsylvania
About this file
This is a Non-Collusion Affidavit form prepared by Herbert, Rowland & Grubic, Inc., applicable to bidding opportunities with the Elizabethtown Area Water Authority in Pennsylvania. The affidavit must be completed and sworn by an authorized representative of the bidding contractor for the Water Main Replacement Project Phase 4 (Contract No. WR-4). The contractor is required to certify that bid pricing has been developed independently without consultation, communication, or agreement with other contractors or potential bidders. Bidders must affirm that bid prices have not been disclosed to other firms prior to bid opening and that no attempts have been made to induce other firms to refrain from bidding or submit noncompetitive bids. The affidavit requires certification that the bid is submitted in good faith and not pursuant to any agreement or discussion with other firms to submit complementary or noncompetitive bids.
The affidavit further requires contractors and their affiliates, subsidiaries, officers, directors, and employees to disclose any convictions or findings of liability in the preceding four years for acts prohibited by state or federal law involving conspiracy or collusion with respect to bidding on public contracts. The contractor must acknowledge that the representations made in the affidavit are material and will be relied upon by the Elizabethtown Area Water Authority in awarding the contract, and that any misstatement constitutes fraudulent concealment. The completed affidavit must be notarized, with the notary public's signature, seal, and commission expiration date required on the document.
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Text version
Herbert, Rowland & Grubic, Inc. 00 45 19 - 1 009280.0426
NON-COLLUSION AFFIDAVIT
STATE OF :
S.S.
COUNTY OF : CONTRACT NO.
I state that I am [Title] of [Contractor] 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) _________________________________ (Contractor), its affiliates, subsidiaries, officers, directors and employees 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 respect to bidding on any public contract, except as follows:
I state that (Contractor) understands and acknowledges that the above representations 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.
SWORN TO AND SUBSCRIBED BEFORE ME
THIS DAY OF Name and Company Position
Notary Public Signature Date
(SEAL)
My Commission Expires:
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