7-Doc 00 45 19 - NON-COLLUSION AFFIDAVIT.pdf
PDF 80 KB Posted
- Attached to
- 2201256.01 - Whistlestop Park
- Solicitation number
- US.160528
- Issued by
- Montgomery County, Pennsylvania
About this file
Non-Collusion Affidavit for Montgomery Township Procurement
This is a Non-Collusion Affidavit template document required for bid submissions to Montgomery Township, Pennsylvania. The affidavit serves as a sworn statement in which the bidder certifies that they have not engaged in any collusive practices, anti-competitive agreements, or restraints on free competitive bidding related to the contract opportunity. The document requires the bidder's authorized representative to affirm under oath that all statements contained in the proposal are true and accurate, and that the bidder has not been convicted or found liable for conspiracy or collusion in bidding on any public contract within the preceding three years. The affidavit must be notarized and submitted as part of the overall bid package to Montgomery Township, which relies upon the truthfulness of these statements in making contract awards.
The affidavit further requires bidders to warrant that no intermediary agents or selling agencies have been retained on a commission, percentage, brokerage, or contingent fee basis, except for bona fide employees or established commercial agencies maintained by the contractor. The document template includes signature lines for the contractor's authorized representative and a notary public, along with spaces for the date and commission expiration. While the affidavit does not prohibit governmental agencies from accepting bids from parties with prior collusion convictions, such history may serve as grounds for administrative suspension, debarment, or consideration of contractor responsibility in contract award decisions at the agency's discretion.
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Text version
NON-COLLUSION AFFIDAVIT
00 45 19-1
DOCUMENT 00 45 19
NON-COLLUSION AFFIDAVIT
COMMONWEALTH OF:
COUNTY OF :
I,_______________________, of _____________________________, (Name) (Name of Contractor) in the County of _____________ and the State of ________________, of full age, being duly sworn according to law on my oath depose and say that:
I am of the firm of _______________________________________, the Bidder making the Proposal for the above Project, and that I executed the said Proposal with full authority so to do; that said Bidder has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named Project; and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the Montgomery Township relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the Contract for the said Project, the undersigned, on behalf of the Bidder, has not 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 within the last three (3) years.
A person's affidavit stating that the person has 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 within the last three (3) years, does not prohibit a governmental agency from accepting a bid from or awarding a contract to that person, but may be a ground for administrative suspension or debarment at the discretion of a governmental agency under the rules and regulations of that agency, or, in the case of a governmental agency with no administrative suspension or debarment regulations or procedures, may be a ground for consideration on the question whether such agency should decline to award a contract to that person on the basis of a lack of responsibility.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by
(Name of Contractor)
(Signature)
(Print or Type Name and Title)
Subscribed and sworn to before me this _____ day of ________________, 20___.
Notary Public of
My commission expires _________________, 20___.
END OF DOCUMENT
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