3-Affidavit.pdf
PDF 163 KB Posted
- Attached to
- Hazardous Material Cleanup and Disposal Services
- Solicitation number
- RFQ-25-0093
- Issued by
- Johnson County, Kansas
About this file
This is an affidavit form required by the City of Olathe, Kansas for contractors and vendors responding to city solicitations. The document serves as a sworn statement that must be completed, notarized, and submitted as part of the bidding process for any contract, job work, or service opportunity with the City of Olathe. The form requires the authorized representative of the responding firm to attest under oath to several key declarations regarding potential conflicts of interest and ethical compliance.
The affidavit specifically requires firms to declare whether any City of Olathe officers, agents, or employees have financial interests in their company or would benefit from any awarded contract. Additionally, respondents must certify that they have not participated in collusion or any acts in restraint of trade related to the city's solicitation process. The form must include the firm's federal tax identification number, be signed by an authorized representative, and be notarized with official seal and commission expiration date. This document appears to be a standard procurement integrity requirement designed to ensure transparency and fair competition in the city's contracting processes.
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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 .