4-00 45 19 Non Collusion Affidavit.pdf
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- Solicitation number
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- Issued by
- Union County, Pennsylvania
About this file
This is a Non-Collusion Affidavit form required for the Water System Reliability Improvements Project (Contract No. 002198.0475) and the Cherry Street Sewer Replacement Project (Contract No. 2026-01) issued by the Borough of Mifflinburg in Union County, Pennsylvania. The affidavit must be completed and sworn before a notary public by an authorized representative of the bidding contractor. The document certifies that the bid price has been developed independently without consultation, communication, or agreement with any other contractor or potential bidder, and that the bidder has not disclosed or will not disclose its bid amount to any other bidder prior to bid opening. The affidavit further confirms that no attempt has been made to induce any firm to refrain from bidding, to submit a higher bid, or to submit a noncompetitive or complementary bid. The bidder represents that it understands the affidavit's representations are material and will be relied upon by the Borough in awarding the contract.
The affidavit requires the contractor to declare that it and its affiliates, subsidiaries, officers, directors, and employees have not been convicted or found liable within the past four years for any act involving conspiracy or collusion with respect to bidding on public contracts under state or federal law in any jurisdiction. Any misstatement in the affidavit is treated as fraudulent concealment. The form must be completed with the contractor's name, title, state, county, and contract number, and must include the notary public's signature, seal, and commission expiration date. This document is a mandatory submission requirement for all bidders on both the sewer and water system projects, which are competitively bid through the PennBid platform with bid openings scheduled for February 12, 2026, and April 16, 2026, respectively.
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Text version
Herbert, Rowland & Grubic, Inc. 00 45 19 - 1 002198.0475
NON-COLLUSION AFFIDAVIT
STATE OF :
S.S.
COUNTY OF : CONTRACT NO.
I state that I am [Title] of [Contractor] and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers. I am the person responsible in my firm for the price(s) and the amount of this bid.
I state that:
(1) The price(s) and amount of this bid have been arrived at independently and without consultation, communication or agreement with any other contractor, bidder or potential bidder.
(2) Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor approximate amount of this bid, have been disclosed to any other firm or person who is a bidder or potential bidder, and they will not be disclosed before bid opening.
(3) No attempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or noncompetitive bid or other form of complementary bid.
(4) The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive bid.
(5) _________________________________ (Contractor), its affiliates, subsidiaries, officers, directors and employees and have not, in the last four years, 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, except as follows:
I state that (Contractor) understands and acknowledges that the above representations are material and important, and will be relied on by the
______________________ (Owner) in awarding the contract(s) for which this bid is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from the (Owner) of the true facts relating to the submission of bids for this contract.
SWORN TO AND SUBSCRIBED BEFORE ME
THIS DAY OF Name and Company Position
Notary Public
Signature Date
(SEAL)
My Commission Expires:
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