Attachment B Non-Collusion Affidavit Form_1.docx
DOCX document 28 KB Posted
- Attached to
- DPH | Radiology Registry
- Solicitation number
- SFGOV-0000012046
- Issued by
- San Francisco County, California
About this file
This is a Non-Collusion Affidavit form for the Department of Public Health's Radiology Registry Request for Proposals (SFGOV-0000012046) issued by the City and County of San Francisco, California. The proposal seeks qualified firms to provide professional temporary radiology technologists and radiology support staff to the San Francisco Health Network, including Zuckerberg San Francisco General Hospital & Trauma Center, Laguna Honda Hospital, Jail Health Services, and SFHN Ambulatory Care sites. All referred staff must be credentialed and competent according to requirements outlined in the Scope of Work. The RFP was published on September 2, 2026, with a deadline for questions on September 8, 2026 and an estimated Q&A addendum posting on September 11, 2026. Proposals are due by 2:00 PM PT on September 16, 2026. The estimated announcement of award is October 2026, with a Health Commission presentation potentially scheduled for December 2026 and an estimated contract start date of January 1, 2027.
The Non-Collusion Affidavit must be completed and submitted as part of Electronic File #2 and requires certification from a duly authorized representative of the proposing entity. The affidavit certifies that the proposal is genuine and not collusive or sham, that no inducements or solicitations have been made to other proposers, that no agreements exist to fix proposal prices or cost elements, and that all statements in the proposal are truthful. The form requires the legal name of the company, the authorized representative's printed name and title, the date, and the authorized representative's signature. No pricing terms, set-asides, incumbent information, or funding amounts are specified in this affidavit document.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment B Non-Collusion Affidavit Request for Proposals SFGOV- 0000012046 Radiology Registry All fields are required. This form must be completed and included with Electronic File #2.
Non-Collusion Affidavit The undersigned deposes and says that they are a duly authorized representative of the party making the foregoing Proposal. The Proposal is not made in the interests of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Proposal is genuine and not collusive or sham. The Proposer has not directly or indirectly induced or solicited any other Proposer to submit a false or sham Proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any Proposer or anyone else to submit a sham Proposal, or to have anyone refrain from proposing. The Proposer has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the Proposal price of the Proposer or any other Proposer, or to fix any overhead, profit, or cost element of the Proposal price, or of that of any other Proposer, or to secure any advantage against the public body awarding the contract or anyone interested in the proposed contract. All statements contained in the Proposal are true. The Proposer has not, directly or indirectly, submitted its Proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company, association, organization, Proposal depository, or any other member or agent thereof to effectuate a collusive or sham Proposal.
Legal Name of Company (Proposer): Click or tap here to enter text.
Authorized Representative’s Printed Name: Click or tap here to enter text.
Authorized Representative’s Title: Click or tap here to enter text.
Date: Click or tap here to enter text.
Authorized Representative’s Signature:
File details come from the government source that posted it. Updated .