3-Affidavit.pdf
PDF 163 KB Posted
- Solicitation number
- RFP-25-0102
- Issued by
- Johnson County, Kansas
About this file
This document is an Affidavit from the City of Olathe, Kansas, designed to verify a firm's ethical standing and compliance when responding to a city solicitation. The affidavit requires the respondent to disclose any potential conflicts of interest, specifically addressing whether any City of Olathe officers, agents, or employees have direct or indirect financial interests in the firm or would benefit financially from any contract awarded.
The affidavit contains four key attestations: the signatory's authorization to represent their firm, a declaration of no financial conflicts of interest with City employees, confirmation that no City employees would benefit financially from the contract, and a statement that the firm has not engaged in collusive practices or trade restraints. The document requires the firm's details including name, Federal Tax ID, contact information, and must be signed and notarized, serving as a legal declaration of the firm's ethical commitment and transparency in the procurement process.
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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 .