3-Affidavit.pdf
PDF 163 KB Posted
- Attached to
- Streetlight Supplies
- Solicitation number
- IFB-25-0094
- Issued by
- Sumner County, Kansas
About this file
This is an affidavit form required by the City of Olathe, Kansas for contractors bidding on city solicitations. The document serves as a sworn statement that must be completed by authorized representatives of firms seeking to provide goods or services to the City of Olathe through any procurement process issued by the city.
The affidavit requires the bidding firm to disclose any financial interests that City of Olathe officers, agents, or employees may have in the contracting firm or would receive from any resulting contract payments or profits. The form also includes an anti-collusion clause where the firm must certify that it has not participated in any collusive activities or acts in restraint of trade related to the city's solicitation. The document must be notarized and includes fields for the firm's federal tax identification number, authorized signatory information, and complete contact details including mailing address, phone, fax, and email.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2-City of Olathe Instruction and Terms and Conditions Form.pdf | ||
| 1-IFB-25-0094 Streetlight Supplies.pdf |
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Text version
CITY OF OLATHE, KANSAS
AFFIDAVIT
STATE OF )
) SS.
COUNTY OF )
of the City of , (Name of Individual)
County of , State of , being duly sworn on her or his oath, states;
1. That I am the (Title) of (Firm Name), and have been authorized by said firm to make this affidavit on its behalf;
2. (Check the box the applies) No officer, agent or employee of the City of Olathe, Kansas is financially interested, directly or indirectly, in what firm is offering to sell to the City pursuant to any solicitation issued by the City of Olathe;
OR
The following officer(s), agent(s), or employee(s) of the City of Olathe would be financially interested in or receive a benefit from the profit or payments of any contract, job work, or service provided to the City of Olathe: (list all such officers, agents, or City employees on a separate sheet);
3. (Check the box that applies) If firm were awarded any contract, job work, or service for the City of Olathe, Kansas, no officer, agent or employee of the City would be financially interested in or receive any benefit from the profit or payments of such;
OR
The following officer(s), agent(s), or employee(s) of the City of Olathe would be financially interested in or receive a benefit from the profit or payments of any contract, job work, or service provided to the City of Olathe: (list all such officers, agents, or City employees on a separate sheet);
4. Firm has not participated in collusion or committed any act in restraint of trade, directly or indirectly, which bears upon anyone's response or lack of response any solicitation issued by the City of Olathe.
(Firm Name) Federal Tax ID #
By: (Signature) Subscribed and sworn before me this day of
(Printed Name) 20
(Title)
Mailing Address NOTARY PUBLIC in and for the County of
City, State, Zip Code State of
Phone Fax My commission expires:
Email SEAL
| CITY OF OLATHE, KANSAS |
| AFFIDAVIT |
| COUNTY OF ) |
| County of , State of , |
| OR |
| OR |
File details come from the government source that posted it. Updated .