3-Form 5 - Non-Collusion Affidavit.pdf
PDF 178 KB Posted
- Solicitation number
- 206-26-PLN-RFQ
- Issued by
- Cameron County, Texas
About this file
This is a Non-Collusion Affidavit form issued by the City of Brownsville Procurement Department for FY26 (Version 2, October 2025) in connection with the Southmost Area Corridor Study and Policy Initiative. The form requires respondents to certify that their proposals are submitted independently without consultation, communication, agreement, or understanding with competing respondents regarding prices, pricing methodologies, intent to submit responses, or any other competitive matters. Respondents must also affirm they have not entered into arrangements to limit competition, fix prices, or influence the solicitation award; have not offered gratuities or favors to city officials; and have not obtained preferential information unavailable to other respondents. The certification requires an authorized representative's signature, printed name, title, date, company name, and phone number.
The affidavit obligates respondents to comply with all applicable state, federal, and local laws regarding antitrust, bribery, collusion, and improper influence, with violations potentially resulting in response rejection, contract termination, and legal action by the City of Brownsville. Respondents are advised that submitting false statements or misrepresentations constitutes a violation of Texas Penal Code 37.10 (Tampering with a Governmental Record) and may result in disqualification or prosecution. This form is a standard compliance document required as part of the submission process for the consultant services solicitation related to the Southmost area planning study.
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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: |
File details come from the government source that posted it. Updated .