3-Form 5 - Non-Collusion Affidavit.pdf
PDF 178 KB Posted
- Solicitation number
- 153-26-AIR-RFQ
- Issued by
- Cameron County, Texas
About this file
This is a Non-Collusion Affidavit form issued by the City of Brownsville's Procurement Department (FY26 - Version 2, October 2025) for the Airport Landside Professional Architectural and Engineering Services solicitation in Texas. The form serves as a certification document that must be completed and signed by all respondents submitting proposals. By executing this affidavit, respondents attest that their bids are submitted independently without consultation, communication, or agreement with competing respondents regarding prices, calculation methods, submission intent, or any other competitive matters. Additionally, respondents certify that they have not engaged in any agreements to limit competition, fix prices, or influence the award of the solicitation.
Respondents further certify compliance with all applicable state, federal, and local laws governing antitrust, bribery, collusion, and improper influence, and acknowledge that they have not sought preferential information unavailable to other bidders. The form requires authorized signatures from company representatives along with printed names, titles, dates, company names, and phone numbers. Respondents are advised that submitting false statements or misrepresentations on this certification constitutes a violation of Texas Penal Code 37.10 and may result in response rejection, contract termination, and/or legal action by the City of Brownsville. This affidavit is mandatory for all bidders participating in the solicitation process.
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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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| Title_6: |
| Date_5: |
| Company Name_5: |
| Phone_5: |
| Signature5_es_:signer:signature: |
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