18._CCHCS-MC-379-_Non-Collusion_Dec.pdf
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- Attached to
- Electrocardiograph (ECG) Equipment and Cardiologist Over-Read and Interpretation Services SD23-00094
- Solicitation number
- 0000033006
- Issued by
- California
About this file
This document is a Non-Collusion Declaration for a State of California contract opportunity with Proposal Number SD23-00094 CCHCS-MC-379. The declaration requires the bidder to affirm that their bid is genuine and not collusive or sham, and that they have not directly or indirectly colluded, conspired, or agreed with any other bidder to fix the bid price or any element of the bid. The bidder also must declare that no owner, partner, member, director, officer, chief financial officer, manager, or employee of the bidder's organization shall be an owner, partner, member, director, officer, chief financial officer, manager, or employee of any other bidder to this Request for Proposal.
The declaration indicates this is for a competitive bid process, and the bidder must sign and submit this non-collusion affidavit as part of their proposal. There is no information provided about the specific products, services, quantities, response dates, award dates, or contract term.
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Text version
Proposal Number: SD23-00094
CCHCS-MC-379 – Non-Collusion Declaration Rev. 09/13/2017
NON-COLLUSION DECLARATION
The undersigned declares:
1. I am the (Title) of (Name of Bidder), the party making the foregoing bid.
2. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham bid. The Bidder has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham bid, or to refrain from bidding. The Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other Bidder. All statements contained in the bid are true. The Bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
3. No owner, partner, member, director, officer, chief financial officer, manager, or employee of Bidder shall be an owner, partner, member, director, officer, chief financial officer, manager, or employee of any other Bidder to this Request for Proposal.
4. If the Bidder is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, I hereby represent that I have full power to execute, and do execute, this declaration on behalf of the Bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on (Date), at (City/State).
Signature
Printed Name
Attachment 18
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