Borough of Doylestown 00 45 19 Non-Collusion Affidavit 2400754 - Fanny Chapman - Main Pool Repairs Page 1 of 1

COMMONWEALTH OF:

COUNTY OF :

I,_______________________, of _____________________________, (Name) (Name of Contractor) in the County of _____________ and the State of ________________, of full age, being duly sworn according to law on my oath depose and say that:

I am of the firm of _______________________________________, the Bidder making the Proposal for the above Project, and that I executed the said Proposal with full authority so to do; that said Bidder has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named Project; and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the Borough of Doylestown relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the Contract for the said Project, the undersigned, on behalf of the Bidder, has not been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction involving conspiracy or collusion with respect to bidding on any public contract within the last three (3) years.

A person's affidavit stating that the person has been convicted or found liable for any act, prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract within the last three (3) years, does not prohibit a governmental agency from accepting a bid from or awarding a contract to that person, but may be a ground for administrative suspension or debarment at the discretion of a governmental agency under the rules and regulations of that agency, or, in the case of a governmental agency with no administrative suspension or debarment regulations or procedures, may be a ground for consideration on the question whether such agency should decline to award a contract to that person on the basis of a lack of responsibility.

I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by

(Name of Contractor)

(Signature)

(Print or Type Name and Title)

Subscribed and sworn to before me this _____ day of ________________, 20___.

Notary Public of

My commission expires _________________, 20___.

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