3-TOH-120 - Affidavit of Non-Collusion and of Non-Interest of Toho Employees.pdf
PDF 57 KB Posted
- Attached to
- Capital Improvement Funding
- Solicitation number
- RFLC-26-001
- Issued by
- Osceola County, Florida
About this file
This is an Affidavit of Non-Collusion and of Non-Interest of Toho Employees form issued by the Tohopekaliga Water Authority ("Toho") in Florida for use with formal solicitations. The form must be completed and submitted by all vendors responding to Toho solicitations. The affidavit requires the authorized representative of the vendor to certify that they are legally authorized to bind the vendor, that only the parties named in the solicitation response have an interest in the bid, and that no officer, employee, or agent of Toho or any competing vendor has an interest in the response. Additionally, the vendor must affirm that the solicitation response was prepared without fraud, collusion, or restraint on free competition, and that it represents fair competition among all bidders.
The form requires the authorized representative to make certifications under penalty of perjury, confirm they are over 18 years of age and competent to make such certifications, and be notarized. The notarization section requires identification of the state and county where the acknowledgment occurs, the date, the notary's signature and seal, and confirmation that the signatory is either personally known to the notary or has provided identification. The form is standardized as Form TOH-120, version 03/2024, and applies to all sealed bid solicitations and loan term requests issued by the Authority.
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Text version
FORM
TOH-120
v: 03/2024
Affidavit of Non-Collusions and of Non-Interest of Toho Employees
Form Page
Instructions: “Vendor(s)”, defined as any person or entity responding to a formal solicitation issued by the Tohopekaliga Water Authority (“Toho”), must submit this form with their Solicitation Responses.
The terms “Contract” and “Agreement” may be interchangeably used.
Vendor Name (as on Sunbiz.org):
Solicitation/Contract Number:
Affidavit of Non-Collusion and of Non-Interest of Toho Employees
The undersigned hereby certifies that they are authorized to legally bind the Vendor of this Solicitation Response, that the only person(s) or party(s) interested in this Solicitation Response are those named in the Solicitation Response, that no officer, employee, or agent of the Tohopekaliga Water Authority or any other Vendor is interest in this Solicitation Response, that this Solicitation Response is made without fraud, that this Solicitation Response is made with no past or present collusion with any other person, firm, or corporation.
By submitting a Solicitation Response to the above-referenced Solicitation, Vendor also represents that this Solicitation Response has been prepared without collusion or fraud and in fair competition with other Vendors, without any restraint on free competition, and acknowledges that TOHO is acting in reliance upon that representation.
The undersigned hereby represents that they: make the above certifications based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certifications; and are authorized to legally bind and make the above certifications on behalf of Vendor.
Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the above sworn statement.
By:
Authorized Representative on behalf of Vendor
Printed Name:
Official Title:
STATE OF _________________
COUNTY OF _______________
The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.
(Seal)
Signature of Notary Public
Name of Notary Typed, Printed or Stamped
File details come from the government source that posted it. Updated .