26-HR09 RFP Form A.PDF
PDF 131 KB Posted
- Attached to
- HEALTH INSURANCE AND BENEFIT BROKER
- Solicitation number
- 26-HR09
- Issued by
- Dane County, Wisconsin
About this file
This is a Signature Affidavit Form A for RFP #26-HR09, submitted by the City of Wisconsin for a health insurance and benefits broker position covering the 2027-2029 contract term. The form requires proposers to provide their legal company name, signature of an authorized representative, printed name of the signatory, and the date of submission. All proposers must certify that they have not engaged in collusion, have independently developed their proposals without coordination with competitors, have not disclosed their proposals prior to opening, and attest to the truthfulness of all submissions under penalty of perjury.
The form mandates that proposers agree to all terms, conditions, and specifications outlined in the City's Request for Proposal and declare that their attached proposal and pricing comply with these requirements. This affidavit serves as a binding certification document required for submission with all proposal responses and establishes the legal accountability of the submitting party for the accuracy and integrity of their bid.
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Other files
| File | Type | Posted |
|---|---|---|
| 26-HR09 RFP Form B.PDF | ||
| City of Sun Prairie 2026 Renewal Folder.pdf | ||
| 26-HR09 RFP Form D.PDF | ||
| 26-HR09 RFP.PDF | ||
| 26-HR09 RFP Form F.PDF | ||
| 26-HR09 Draft Contract.PDF | ||
| 26-HR09 Appendix A.PDF | ||
| 26-HR09 RFP Form E.PDF | ||
| 26-HR09 RFP Form C.PDF | ||
| 26-HR09 QA FORM.PDF | ||
| City of Sun Prairie 2025 Renewal Folder.pdf | ||
| 26-HR09 RFP Form G.PDF | ||
| Census Data.xlsx | XLSX spreadsheet |
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Text version
This form must be returned with your response.
In signing Proposals, we certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit Proposals, that Proposals have been independently arrived at, without collusion with any other Proposers, competitor or potential competitor; that Proposals have not been knowingly disclosed prior to the opening of Proposals to any other Proposers or competitor;
that the above statement is accurate under penalty of perjury.
The undersigned, submitting this Proposal, herby agrees with all the terms, conditions, and specifications required by the City in this Request for Proposal, declares that the attached Proposal and pricing is in conformity therewith, and attests to the truthfulness of all submissions in response to this solicitation.
Proposers shall provide the information requested below. Include the legal name of the Proposers and signature of the person(s) legally authorized to bind the Proposers to a contract.
COMPANY NAME
SIGNATURE DATE
PRINT NAME OF PERSON SIGNING
Form A: Signature Affidavit
RFP #: 26-HR09
File details come from the government source that posted it. Updated .