4-Non-Collusion Statement -Attachment 2.pdf
PDF 375 KB Posted
- Solicitation number
- HSS-26-034
- Issued by
- Delaware
About this file
This document is a Non-Collusion Statement for the Delaware Health and Social Services, Division of Public Health, related to Contract No. HSS-26-034 for Delaware's Spay & Neuter Program – System Enhancement Project. The solicitation has a response deadline of January 8, 2026, at 1:00 PM EST/EDT. The form requires vendors to certify that they have not engaged in any collusive bidding practices and are not a sub-contractor to another primary vendor submitting a proposal for this solicitation.
The document includes a section for vendors to provide company classification details, including options to self-identify as a Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), or Service-Disabled Veteran Owned Business Enterprise (SDVOBE). Vendors must also affirm whether they have been subject to any federal, state, or local government suspension or debarment within the past five years. The form requires complete company information, including contact details, federal tax ID, state license number, and an authorized representative's signature.
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Text version
Delaware Health and Social Services Division of Public Health
Attachment 2
CONTRACT NO.: HSS-26-034
CONTRACT TITLE: Delaware’s Spay & Neuter Program – System Enhancement Project DEADLINE TO RESPOND: January 8, 2026, at 1:00 PM EST/EDT
NON-COLLUSION STATEMENT (COMPLETE THIS FORM IN ITS ENTIERTY)
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.
COMPANYNAME (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 .