5-Exhibit D - Non-Collusion Agreement.pdf

FORM OF NON-COLLUSION AFFIDAVIT

State of _____________________________ :

SS

County of ___________________________ :

I state that I am ________________________of ______________________________

(Title) (Name of Firm) 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 Proposal.

I state that:

1. The price(s) and amount of this Proposal have been arrived at independently and without consultaƟon, communicaƟon or agreement with any other contractor, Proposer or potenƟal Proposer.

2. Neither the price(s) nor the amount of this Proposal, and neither the approximate price(s) nor approximate amount of this Proposal, have been disclosed to any other firm or person who is a Proposer or potenƟal Proposer, and they will not be disclosed before Proposal opening.

3. No aƩempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a Proposal higher than this Proposal, or to submit any intenƟonally high or noncompeƟƟve Proposal or other form of complementary Proposal.

4. The Proposal 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 noncompeƟƟve Proposal.

5. _________________________________________________, its affiliates, (Name of My Firm) subsidiaries, officers, directors and employees are not currently under invesƟgaƟon by any governmental agency and have not in the last three years been convicted or found liable for any act prohibited by State or Federal Law in any jurisdicƟon, involving conspiracy or collusion with respect to bidding on any public contract except as follows:

I state that _________________________________________________ understands

(Name of My Firm) and acknowledges that the above representaƟons are material and important, and will be relied on by MONTGOMERY COUNTY COMMUNITY COLLEGE in awarding the contract(s) for which this Proposal is submiƩed. I understand and my firm understands that any misstatement in this Affidavit is and shall be treated as fraudulent concealment from MONTGOMERY COUNTY COMMUNITY COLLEGE of the true facts relaƟng to the submission of Proposals for this contract.

(Name)

(Company PosiƟon)

SWORN TO AND SUBSCRIBED

BEFORE ME THIS ______________ DAY

OF ________________________, 20___

Notary Public My Commission Expires

INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT

1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this Proposal. According to SecƟon 4507 of the Pennsylvania Commonwealth Procurement Code, 62 Pa.C.S. § 4507, governmental agencies may require Non-Collusion Affidavits to be submiƩed together with Proposals.

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

3. Proposal rigging and other efforts to restrain compeƟƟon, and the making of false SWORN statements in connecƟon with the submission of Proposals are unlawful and may be subject to criminal prosecuƟon. The person who signs the Affidavit should examine it carefully before signing and assure himself or herself that each statement is true and accurate, making diligent inquiry, as necessary, of all of persons employed by or associated with the Proposer with responsibiliƟes for the preparaƟon, approval or submission of the Proposal.

4. In case of a Proposal submiƩed by a joint venture, each party to the venture must be idenƟfied in the Proposal Documents, and an Affidavit must be submiƩed separately on behalf of each party.

5. The term “Complementary Proposal” as used in the Affidavit has the meaning commonly associated with that term in the bidding process, and includes the knowing submission of Proposals higher than the Proposal of another firm, any intenƟonally high or noncompeƟƟve Proposal, and any other form of Proposal submiƩed for the purpose of giving a false appearance of compeƟƟon.

6. Failure to file an Affidavit in compliance with these instrucƟons may result in disqualificaƟon of the Proposal.

7. A Proposer’s statement that it has been convicted or found liable for any act prohibited by Federal or State Law in any jurisdicƟon involving conspiracy or collusion with respect to bidding on any public contract within the last three (3) years does not prohibit a government agency from accepƟng a Proposal from or awarding a contract to that Proposer, but it may be grounds for administraƟve suspension or debarment in the discreƟon of the government agency under the rules and regulaƟons of that agency or, in the case of a government agency with no administraƟve suspension or debarment regulaƟons or procedures, may be grounds for consideraƟon on the quesƟon of whether the agency should decline to award a contract to that person on the basis of lack of responsibility.

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