4-Non-Collusion Declaration 03.14.2024.pdf
PDF 135 KB Posted
- Attached to
- Clinical Review Services
- Solicitation number
- 25-06803
- Issued by
- San Bernardino County, California
About this file
This is a Non-Collusion Declaration form required for submission with quotations or proposals in response to a Clinical Review Services contract opportunity in California. The declaration must be executed by the bidder and serves as a legal attestation that the bid is genuine, independently prepared, and free from any collusive or sham arrangements with other bidders. The form requires the bidder to certify under penalty of perjury that no coordination, price-fixing, or information sharing has occurred with competing bidders, and that all statements contained in the bid are truthful and accurate.
The declaration must be signed and dated by an authorized representative of the bidding entity, with the signatory identifying their title and relationship to the bidder. For bids submitted by corporations, partnerships, joint ventures, limited liability companies, or other entities, the individual executing the declaration represents that they have full authority to do so on behalf of the organization. The completed and signed form must be submitted with the bid response to IEHP (Inland Empire Health Plan) as part of the procurement process for Clinical Review Services.
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Text version
Non-Collusion Declaration 03.14.2024
NON-COLLUSION DECLARATION
TO BE EXECUTED BY BIDDER AND SUBMITTED WITH QUOTATION/PROPOSAL
The undersigned declares:
I am the of , the party making the foregoing bid.
The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on:
[date], at [city], [state].
Signature Date
| date: |
| at city: |
| state: |
| Date: |
| Signature3_es_:signer:signature: |
| Text4: |
| Text5: |
File details come from the government source that posted it. Updated .