3-Form 5 - Non-Collusion Affidavit.pdf
PDF 178 KB Posted
- Attached to
- Brownsville Metro Vending Concession
- Solicitation number
- 139-26-BMT-RFP
- Issued by
- Cameron County, Texas
About this file
This is a Non-Collusion Affidavit form issued by the City of Brownsville Procurement Department in October 2025 for the Brownsville Metro Vending Concession solicitation. The form certifies that each respondent's proposal is submitted independently and without consultation, communication, or agreement with competing respondents regarding prices, calculation methods, submission intent, or other competitive matters. Respondents must affirm they have not entered into agreements to limit competition, fix prices, or influence contract award, and have not offered gratuities or improper consideration to City officials. The form requires authorized certification with signature, printed name, title, date, company name, and phone number.
Respondents certify compliance with all applicable state, federal, and local laws regarding antitrust, bribery, collusion, and improper influence, acknowledging that violations may result in response rejection, contract termination, and legal action. Respondents further certify they have not obtained or attempted to obtain information unavailable to other respondents to gain preferential advantage and will not seek such information in the future. False statements or misrepresentations in connection with this certification violate Texas Penal Code 37.10 and may result in disqualification or prosecution. All respondents must complete and sign this affidavit as part of their submission for the vending machine concession opportunity at Brownsville Metro terminal locations.
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Text version
FY26 – Version 2 Procurement Department October 2025
Form 5 – Non-Collusion Affidavit
Purpose
This form ensures that each Respondent certifies its offer is made independently and without any attempt to restrict or suppress competition.
Certification
By signing below, the Respondent certifies and affirms that:
1. The response submitted is made independently and without consultation, communication, agreement, or understanding with any competing Respondent as to:
o Prices;
o Methods or factors used to calculate prices;
o Intent to submit, or refrain from submitting, a response; or o Any other matter relating to competition.
2. The Respondent has not directly or indirectly entered into any agreement or arrangement with any other person, firm, or corporation to limit competition, to fix prices, or to influence the award of this solicitation.
3. The Respondent has not, and will not, offer or give any gratuity, favor, or thing of value to any officer, employee, or representative of the City of Brownsville for the purpose of influencing or obtaining favorable treatment in connection with this solicitation.
4. The Respondent has not received or attempted to obtain information not available to other Respondents so as to gain a preferential advantage in the solicitation or award process, and will not seek or accept such information in the future.
5. The Respondent certifies compliance with all applicable state, federal, and local laws, regulations, and ordinances relating to antitrust, bribery, collusion, and improper influence, and agrees that any violation may result in rejection of its response, contract termination, and/or legal action by the City.
6. The Respondent understands that submitting a false statement or misrepresentation in connection with this certification is a violation of Texas Penal Code § 37.10 (Tampering with a Governmental Record) and may result in disqualification or prosecution.
Authorized Certification
Signature: ____________________________________________
Printed Name: _________________________________________
Title: _________________________________________________
Date: ______________________
Company Name: ________________________________________
Phone: ______________________
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| Signature5_es_:signer:signature: |
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