8-HSS-26-033 - Indigent Burial - Attachment 2 - Non-Collusion Statement.docx
DOCX document 135 KB Posted
- Attached to
- INDIGENT BURIAL AND CREMATION SERVICES
- Solicitation number
- HSS-26-033
- Issued by
- Delaware
About this file
This is a Non-Collusion Statement attachment for a contract solicitation issued by the Delaware Health and Social Services Division of Social Services for indigent burial and cremation services. The Division seeks to establish a pool of experienced vendors capable of providing these services. The proposal deadline is March 13, 2026, at 1:00 PM EDT. The statement serves as a certification requirement for all bidding vendors to confirm they have not engaged in collusion, price-fixing, or any actions that would restrain free competitive bidding. Vendors must confirm they are not sub-contractors to other primary bidders responding to this same solicitation and must acknowledge their acceptance of all solicitation terms, conditions, specifications, and special provisions outlined in the attachments.
The Non-Collusion Statement requires completion by an authorized representative with legal authority to bind the vendor's organization to a formal contract with the State of Delaware. Vendors must provide company information, contact details, and federal employer identification or license numbers. The form includes a certification section requesting disclosure of the vendor's business classification status, including options for Minority Business Enterprise, Woman Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise designations. Additionally, vendors must disclose whether their firm, affiliates, predecessors, or any principals have been subject to federal, state, or local government suspension or debarment within the past five years, with required explanation if applicable.
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Text version
Delaware Health and Social Services
Division of Social Services d
Attachment 2
| CONTRACT NO.: | HSS-26-033 |
| CONTRACT TITLE: | INDIGENT BURIAL AND CREMATION SERVICES |
DEADLINE TO RESPOND: 3/13/2026, at 1:00 PM EDT
NON-COLLUSION STATEMENT
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 Social Services.
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 Social Services.
Corporation
Partnership
Individual
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 image1.png image2.png
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