Attachment B Non-Collusion Affidavit Form_1.docx
DOCX document 28 KB Posted
- Solicitation number
- SFGOV-0000011940
- Issued by
- California
About this file
This is a Non-Collusion Affidavit form required for submission with a Request for Proposals (RFP) issued by the Department of Public Health (DPH) in California for Institutional Master Plan Consulting Services (SFGOV-0000011940). The RFP seeks proposals from qualified and experienced firms to provide professional health planning services supporting DPH's review of hospital Institutional Master Plans. Key dates include the RFP publication on September 9, 2026, a pre-proposal conference on September 18, 2026, a question submission deadline of 5:00 PM PT on September 25, 2026, an estimated Q&A addendum posting on October 2, 2026, and a proposal submission deadline of 2:00 PM PT on October 13, 2026. The estimated award announcement is scheduled for November 2026, with an anticipated Health Commission presentation in May 2027 and a contract start date of June 1, 2027.
The Non-Collusion Affidavit form must be completed and submitted as part of Electronic File #2 with all required fields populated. The form requires an authorized representative of the proposing company to certify under oath that the proposal is genuine, independently prepared without collusion, and contains truthful statements. The affiant must attest that no coordination occurred with other proposers regarding pricing, overhead, profit, cost elements, or other proposal components, and that no fees were paid to facilitate collusive or sham proposals. The form requires the legal company name, authorized representative's printed name and title, date of execution, and the authorized representative's signature.
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Text version
Attachment B Non-Collusion Affidavit Request for Proposals SFGOV-0000011940 Institutional Master Plan Consulting Services 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:
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