3-Affidavit.pdf

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Attached to
Pilot Project for City of Olathe Signage & Wayfinding for Parks, Trails and Unique Places 4-C-035-24
Solicitation number
IFB-25-0103
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 compliance with conflict of interest and fair competition requirements when responding to a city solicitation. The affidavit requires the respondent to declare whether any city officers, agents, or employees have a direct or indirect financial interest in the proposed contract, and to confirm that the firm has not engaged in collusive practices or acts that would restrain trade. The form requires the signatory to provide their name, title, firm name, contact information, and federal tax ID, and must be signed and notarized.

The affidavit provides two key checkbox options for each of two primary declarations: first, whether any city officials have a financial interest in the firm's offering, and second, whether any city officials would benefit financially from the contract if awarded. The document also includes a statement that the firm has not participated in collusion or committed any acts that would improperly influence the bidding process. By executing this document, the firm attests to its ethical business practices and transparency in the municipal 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 .