2-Form 5 - Non-Collusion Affidavit.pdf
PDF 178 KB Posted
- Solicitation number
- 164-26-EPW-IFB
- Issued by
- Cameron County, Texas
About this file
This is a Non-Collusion Affidavit form issued by the City of Brownsville, Texas Procurement Department in October 2025 for the Traffic Signal Improvements project at the intersection of Paredes Line Road at Coffee Road. The form serves as a mandatory certification requirement for all respondents participating in the sealed competitive bid solicitation. By executing this affidavit, respondents certify that their bids are submitted independently without consultation, communication, or agreement with competing respondents regarding prices, pricing methodologies, submission intent, or other competitive matters. Respondents further affirm they have not entered into any agreements to limit competition, fix prices, or influence the award decision, and confirm they have not offered or provided any gratuities, favors, or items of value to City officials or employees to gain preferential treatment.
The affidavit requires respondents to certify compliance with all applicable state, federal, and local laws governing antitrust, bribery, collusion, and improper influence, including Texas Penal Code Section 37.10 regarding tampering with governmental records. Respondents acknowledge that any false statements or misrepresentations may result in response rejection, contract termination, legal action, or criminal prosecution. The form includes signature blocks for authorized representatives, requiring printed name, title, date, company name, and telephone contact information. Violation of the certification requirements carries serious consequences including disqualification from the procurement process and potential legal liability.
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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: ______________________
| Printed Name_5: |
| Title_6: |
| Date_5: |
| Company Name_5: |
| Phone_5: |
| Signature5_es_:signer:signature: |
File details come from the government source that posted it. Updated .