6-Non-Collusion Affidavit.pdf
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- Solicitation number
- 26-003-30
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Non-Collusion Affidavit form required by Creighton Elementary School District #14 in Phoenix, Arizona for use in connection with a Billboard Placement & Advertising Management contract opportunity at Gateway Elementary School. The affidavit must be completed and notarized by the authorized representative of any firm or individual submitting a proposal for billboard installation and management services on the south edge of the Gateway Elementary School property located at 1100 N 35th Street, Phoenix, Arizona 85008. The form requires the affiant to certify under oath that the proposal is genuine and not collusive, that no other offerors have been induced to submit sham proposals or refrain from bidding, and that no collusive actions have been taken to gain an advantage over competitors.
The affidavit further requires certification that the offeror has exercised due diligence to ensure no personal gifts or benefits have been offered to any District personnel involved in contract supervision, planning, recommendations, selection, or financial transactions, in compliance with Arizona Revised Statutes 15-213(O), Arizona Administrative Code R7-2-1042(A.1.L), and R7-2-1003(J). The form must be notarized before a notary public, and remote online notarization is acceptable in accordance with A.R.S. 41-371 through 41-380, provided the notarization includes a statement indicating the use of communication technology.
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Text version
CREIGHTON ELEMENTARY SCHOOL DISTRICT #14
2702 E Flower St, Phoenix, AZ 85016
NON-COLLUSION AFFIDAVIT
State of ____________________ )
) ss.
County of __________________ )
Before me, the undersigned, personally appeared
______________________________________________________________________ , affiant, (Name) the _____________________________________________________________________________ (Title)
(Contractor/Offeror) the persons, corporation, or company who makes the accompanying Proposal, having first been duly sworn, deposes and says:
That such Proposal is genuine and not sham or collusive, nor made in the interest of, or behalf of, any persons not herein named, and that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a sham Proposal, or any other person, firm or corporation to refrain from submitting a Proposal, and that the Offeror has not in any manner sought by collusion to secure for itself an advantage over any other Offeror; and
That Offeror has taken steps and exercised due diligence to ensure that Offeror has not offered, conferred, or agreed to confer any personal gift or benefit on a person who supervises or participates in contracts, purchases, payments, claims or other financial transactions, or on a person who supervises or participates in planning, recommending, selecting or contracting for materials, services, goods, construction or construction services of the District, in accordance with A.R.S. § 15-213(O), A.A.C.
R7-2-1042(A.1.L), and A.A.C. R7-2-1003(J).
(Signature of Affiant)
(Title)
Subscribed and sworn to before me this __________ day of ___________________________ , 20 ____________
Signature of Notary Public in and for the
State of ___________________________________________
County of _________________________________________
THIS FORM MUST BE NOTARIZED
Remote online notarization is acceptable in accordance with A.R.S. §§ 41-371 through 41-380 and should contain a statement substantially as follows: “This remote online notarization involved the use of communication technology.” Resources regarding online notaries for Arizona can be found at: https://azsos.gov/business/notary/enotary https://azsos.gov/business/notary/enotary
File details come from the government source that posted it. Updated .