11-Doc 00 45 19 - NON-COLLUSION AFFIDAVIT.pdf
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- Attached to
- 1121 Horsham Road Demolition (26-01054)
- Solicitation number
- US.258594
- Issued by
- Pennsylvania
About this file
This is a Non-Collusion Affidavit form required by Horsham Township, Pennsylvania for bidders on the 1121 Horsham Road Demolition project (26-01054). The affidavit must be completed and sworn before a notary public by an authorized representative of the bidding firm. The form certifies that the bidder has not engaged in any direct or indirect agreements, collusion, or actions that would restrain free and competitive bidding for the demolition project, which involves removal of an existing residential home, abandonment of existing water and sanitary services at the mains, and grading and permanent stabilization of disturbed areas to match surrounding topography.
The affidavit further requires the bidder to warrant that no person or selling agency has been retained to solicit or secure the contract on commission, percentage, brokerage, or contingent fee basis, except for bona fide employees or established commercial or selling agencies. The bidder must also affirm that they have not been convicted or found liable within the last three years for any act involving conspiracy or collusion with respect to bidding on public contracts under state or federal law. While such a conviction or liability does not automatically prohibit bid acceptance or contract award, it may serve as grounds for administrative suspension, debarment, or consideration of contractor responsibility at Horsham Township's discretion.
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Text version
NON-COLLUSION AFFIDAVIT
00 45 19-1
DOCUMENT 00 45 19
NON-COLLUSION AFFIDAVIT
COMMONWEALTH OF:
COUNTY OF :
I,_______________________, of _____________________________, (Name) (Name of Contractor) in the County of _____________ and the State of ________________, of full age, being duly sworn according to law on my oath depose and say that:
I am of the firm of _______________________________________, the Bidder making the Proposal for the above Project, and that I executed the said Proposal with full authority so to do; that said Bidder has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named Project; and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that Horsham Township relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the Contract for the said Project, the undersigned, on behalf of the Bidder, has not 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.
A person's affidavit stating that the person has 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, does not prohibit a governmental agency from accepting a bid from or awarding a contract to that person, but may be a ground for administrative suspension or debarment at the discretion of a governmental agency under the rules and regulations of that agency, or, in the case of a governmental agency with no administrative suspension or debarment regulations or procedures, may be a ground for consideration on the question whether such agency should decline to award a contract to that person on the basis of a lack of responsibility.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by
(Name of Contractor)
(Signature)
(Print or Type Name and Title)
Subscribed and sworn to before me this _____ day of ________________, 20___.
Notary Public of
My commission expires _________________, 20___.
END OF DOCUMENT
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