1-NON-COLLUSION AFFIDAVIT.pdf
PDF 245 KB Posted
- Attached to
- Palm Bay Aquatic Center
- Solicitation number
- 01-RFQ-27
- Issued by
- Brevard County, Florida
About this file
This is a Non-Collusion Affidavit of Prime Bidder form required for the City of Palm Bay, Florida's Request for Qualifications to operate the Palm Bay Aquatic Center. The affidavit serves as a sworn statement wherein the bidder certifies that the submitted bid is genuine and not collusive or sham in nature. The document requires the bidder's representative to affirm that neither the bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest have engaged in collusion, conspiracy, or agreement with any other bidder regarding bid submission, price fixing, overhead, profit margins, or cost elements. The affiant must also verify that the quoted prices are fair, proper, and untainted by any unlawful agreement or collusion against the City of Palm Bay or any interested parties.
The affidavit must be executed before a notary public in the State of Florida, County of Brevard, with the notary's signature, typed name, notary seal, and serial number affixed. The form requires fields for the affiant's signature, title, and the date of notarization, along with specification of whether the notarization was conducted through physical presence or online notarization. This document is a standard compliance requirement for bid submission and does not contain specific pricing terms, set-asides, incumbent information, funding requirements, or contract award details.
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Text version
SECTION 00301
NON-COLLUSION AFFIDAVIT OF PRIME BIDDER
STATE OF
COUNTY OF
, being duly sworn, deposes and says that:
(1) He/she is of , the (Title) (Firm/Company) Bidder that has submitted the attached Bid.
(2) He/she is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid.
(3) Such Bid is genuine and is not a collusive or sham Bid.
(4) Neither the said Bidder nor any of its officers, partners, owners, agent representatives, employees or parties in interest including this affiant, has in any way, colluded, conspired, or agreed, directly or indirectly, with any other Bidder, firm or person, to submit a collusive or sham Bid in connection with the Agreement for which the attached Bid has been submitted or to refrain from proposing in connection with such Agreement, or has in any manner, directly or indirectly, sought by Agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit or cost element of the Bid price or the Bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance or unlawful Agreement any advantage against the City of Palm Bay, Florida, or any person interested in the proposed Agreement.
(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, or unlawful Agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties of interest, including affiant.
(Signed)
(Title)
STATE OF FLORIDA
COUNTY OF BREVARD
The foregoing instrument was acknowledged before me, by means of ___ physical presence or ___ online notarization, this _______ day of _______________, _______ (year) by
_____________________________, who is personally known to me or who has produced
_______________________________ as identification and who did (did not) take an oath.
(Signature of Notary Public)
(Name of Notary – Typed, printed or stamped)
(Notary Seal / Serial Number)
(Date)
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