2-Form 5 - Non-Collusion Affidavit.pdf
PDF 178 KB Posted
- Solicitation number
- 005-26-EPW-IFB
- Issued by
- Cameron County, Texas
About this file
This document is a Non-Collusion Affidavit (Form 5) for the City of Brownsville's Procurement Department, dated October 2025. The form is designed to ensure that respondents submit independent and competitive proposals without engaging in collusive practices. It requires potential bidders to certify that their responses are made without consultation or communication with competing respondents regarding pricing, submission strategies, or other competitive matters.
The affidavit mandates that respondents affirm they have not entered into any agreements to limit competition, fix prices, or improperly influence the solicitation process. By signing, the respondent agrees to comply with applicable state, federal, and local laws related to antitrust, bribery, and improper influence. The document warns that false statements or misrepresentations could result in disqualification, contract termination, or legal action, specifically noting potential violation of Texas Penal Code § 37.10 regarding tampering with governmental records.
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Text version
FY26 – Version 2 Procurement Department October 2025
Form 5 – Non-Collusion Affidavit
Purpose
This form ensures that each Respondent certifies its offer is made independently and without any attempt to restrict or suppress competition.
Certification
By signing below, the Respondent certifies and affirms that:
1. The response submitted is made independently and without consultation, communication, agreement, or understanding with any competing Respondent as to:
o Prices;
o Methods or factors used to calculate prices;
o Intent to submit, or refrain from submitting, a response; or o Any other matter relating to competition.
2. The Respondent has not directly or indirectly entered into any agreement or arrangement with any other person, firm, or corporation to limit competition, to fix prices, or to influence the award of this solicitation.
3. The Respondent has not, and will not, offer or give any gratuity, favor, or thing of value to any officer, employee, or representative of the City of Brownsville for the purpose of influencing or obtaining favorable treatment in connection with this solicitation.
4. The Respondent has not received or attempted to obtain information not available to other Respondents so as to gain a preferential advantage in the solicitation or award process, and will not seek or accept such information in the future.
5. The Respondent certifies compliance with all applicable state, federal, and local laws, regulations, and ordinances relating to antitrust, bribery, collusion, and improper influence, and agrees that any violation may result in rejection of its response, contract termination, and/or legal action by the City.
6. The Respondent understands that submitting a false statement or misrepresentation in connection with this certification is a violation of Texas Penal Code § 37.10 (Tampering with a Governmental Record) and may result in disqualification or prosecution.
Authorized Certification
Signature: ____________________________________________
Printed Name: _________________________________________
Title: _________________________________________________
Date: ______________________
Company Name: ________________________________________
Phone: ______________________
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