3-Non Collusion Statement -Attachment 2.pdf
PDF 220 KB Posted
- Attached to
- LABORATORY EQUIPMENT MAINTENANCE
- Solicitation number
- HSS-26-009
- Issued by
- New Castle County, Delaware
About this file
This document is a Non-Collusion Statement for a contract issued by Delaware Health and Social Services, Division of Public Health, for Laboratory Equipment Maintenance (Contract No. HSS 26 009). The solicitation has a response deadline of November 10, 2025, at 1:00 PM EST. The document is an attachment (Attachment 2) that requires vendors to certify they have not engaged in collusive bidding practices and are not sub-contractors to another primary vendor submitting a proposal for the same solicitation.
The form includes optional company classification sections for various business enterprise types, including Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), and Service-Disabled Veteran Owned Business Enterprise (SDVOBE). Vendors must also disclose whether they have been subject to any federal, state, or local government suspension or debarment within the past five years. The document provides spaces for vendor details such as company name, authorized representative, contact information, federal employer identification number, and license number.
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Text version
Delaware Health and Social Services Division of Public Health
Attachment 2
CONTRACT NO.: HSS 26 009
CONTRACT TITLE: LABORATORY EQUIPMENT MAINTENANCE
DEADLINE TO RESPOND: November 10, 2025, at 1:00 PM EST
NON-COLLUSION STATEMENT
This is to certify that the undersigned Vendor has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this proposal, and further certifies that it is not a sub-contractor to another Vendor who also submitted a proposal as a primary Vendor in response to this solicitation submitted this date to the State of Delaware, Division of Public Health.
It is agreed by the undersigned Vendor that the signed delivery of this bid represents, subject to any express exceptions set forth at Attachment 3, the Vendor’s acceptance of the terms and conditions of this solicitation including all specifications and special provisions.
NOTE: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Division of Public Health.
COMPANY NAME __________________________________________________________________Check one)
NAME OF AUTHORIZED REPRESENTATIVE
(Please type or print)
SIGNATURE TITLE
COMPANY ADDRESS
PHONE NUMBER FAX NUMBER
EMAIL ADDRESS ______________________________
STATE OF DELAWARE
FEDERAL E.I. NUMBER LICENSE NUMBER_____________________________
COMPANY
CLASSIFICATIONS:
CERT. NO.:
Certification type(s) Circle all that apply
Minority Business Enterprise (MBE) Yes No Woman Business Enterprise (WBE) Yes No Disadvantaged Business Enterprise (DBE) Yes No Veteran Owned Business Enterprise (VOBE) Yes No Service-Disabled Veteran Owned Business Enterprise (SDVOBE) Yes No
[The above table is for informational and statistical use only.]
PURCHASE ORDERS SHOULD BE SENT TO:
(COMPANY NAME)
ADDRESS
CONTACT
PHONE NUMBER FAX NUMBER
EMAIL ADDRESS
AFFIRMATION: Within the past five years, has your firm, any affiliate, any predecessor company or entity, owner, Director, officer, partner or proprietor been the subject of a Federal, State, Local government suspension or debarment?
YES NO if yes, please explain
Corporation
Partnership
Individual
File details come from the government source that posted it. Updated .