5-004500 - Non-Collusion Affidavit.pdf

Borough of Tyrone March 2026 Northwood Water Main Replacement Project

NON-COLLUSION AFFIDAVIT 004500-1

RETTEW Project No.: 1230002822 Contract No. 2026-03

NON-COLLUSION AFFIDAVIT

State of :

: SS

County of :

I state that I am of , and that I am authorized to make (Title) (Name of My Firm) 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. , its affiliates, subsidiaries, officers, directors and employees are not (Name of My Firm) currently under investigation by any governmental agency and have not in the last 3 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 understands and acknowledges that the above representations

(Name of My Firm) are material and important, and will be relied on by in awarding the (Name of Public Entity) contract(s) for which this bid is submitted. I understand and my firm understands that any misstatement of this affidavit is and shall be treated as fraudulent concealment from of the true facts relating to submission of bids for this contract.

(Name of Public Entity)

(Name and Company Position)

SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 20 .

Notary Public My Commission Expires: ________________________

* Involvement in this activity does not prohibit the from accepting this bid or (Name of Public Entity) awarding a contract; but this may be a ground for determining whether the should (Name of Public Entity) decide to award a contract based on a lack of responsibility.

Borough of Tyrone March 2026 Northwood Water Main Replacement Project

NON-COLLUSION AFFIDAVIT 004500-2

RETTEW Project No.: 1230002822 Contract No. 2026-03

INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT

1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this Bid.

According to the Pennsylvania Antibid-Rigging Act, 73 P.S. § 1611 et seq, governmental agencies may require Non-Collusion Affidavits to be submitted together with bids.

2. This Non-Collusion Affidavit must be executed by the member, officer or employee of the Bidder who makes the final decision on prices and the amount quoted in the Bid.

3. Bid rigging and other efforts to restrain competition, and making of false sworn statements in connection with the submission of Bids are unlawful and may be subject to criminal prosecution. The person who signs the Affidavit should examine it carefully before signing and assure themselves that each statement is true and accurate, making diligent inquiry, as necessary, of all other persons employed by or associated with the Bidder with responsibilities for the preparation, approval or submission of the Bid.

4. In the case of a Bid submitted by a joint venture, each party to the venture must be identified in the Bid documents, and an Affidavit must be submitted separately on behalf of each party.

5. The term "Complementary Bid" as used in the Affidavit has the meaning commonly associated with that term in the bidding process, and includes the knowing submission of bids higher than the bid of another firm, any intentionally high or noncompetitive bid, and any other form of bid submitted for the purpose of giving a false appearance of competition.

6. Failure to file an Affidavit in compliance with these instructions will result in disqualification of the Bid.