11-Non-Collusion Affidavit.pdf
PDF 104 KB Posted
- Attached to
- Sports Medicine Exams & Certifications
- Solicitation number
- RFP 27-02-31
- Issued by
- Maricopa County, Tucson City, Arizona
About this file
This is a Non-Collusion Affidavit form required by Tolleson Union High School District in Arizona for the Sports Medicine Exams & Certifications contract opportunity. The affidavit must be completed and notarized by the authorized representative of any bidding contractor or offeror. The form confirms that the proposal submitted is genuine and not collusive, that the offeror has not solicited other offerors to submit sham proposals or refrain from bidding, and that no collusive arrangements have been made to gain competitive advantage. Additionally, the affiant attests that no personal gifts or benefits have been offered to district employees involved in contract supervision, planning, selection, or financial transactions, in compliance with Arizona Revised Statutes Section 15-213(O) and Arizona Administrative Code Regulations R7-2-1042(A.1.L) and R7-2-1003(J).
The affidavit requires the signature of the authorized representative and their title, along with notarization before a notary public. The form includes standard fields for the state and county where the affidavit is executed, the date of execution, and notary public credentials. This document is a mandatory submission requirement and must be notarized to be considered valid for proposal evaluation purposes.
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Text version
NON-COLLUSION AFFIDAVIT
State of ____________________ )
) ss.
County of __________________ )
Before me, the undersigned, personally appeared
______________________________________________________________________ , affiant, (Name) the _____________________________________________________________________________ (Title)
(Contractor/Offeror) the persons, corporation, or company who makes the accompanying Proposal, having first been duly sworn, deposes and says:
That such Proposal is genuine and not sham or collusive, nor made in the interest of, or behalf of, any persons not herein named, and that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a sham Proposal, or any other person, firm or corporation to refrain from submitting a Proposal, and that the Offeror has not in any manner sought by collusion to secure for itself an advantage over any other Offeror; and
That Offeror has taken steps and exercised due diligence to ensure that Offeror has not offered, conferred, or agreed to confer any personal gift or benefit on a person who supervises or participates in contracts, purchases, payments, claims or other financial transactions, or on a person who supervises or participates in planning, recommending, selecting or contracting for materials, services, goods, construction or construction services of the District, in accordance with A.R.S. § 15-213(O), A.A.C. R7-2-1042(A.1.L), and A.A.C. R7-2-1003(J).
(Signature of Affiant)
(Title)
Subscribed and sworn to before me this __________ day of ___________________________ , 20 ____________
Signature of Notary Public in and for the
State of ___________________________________________
County of _________________________________________
THIS FORM MUST BE NOTARIZED
File details come from the government source that posted it. Updated .