Attachment B Non-Collusion Affidavit Form_1.pdf
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- Attached to
- DPH | 503A Sterile Compounding Pharmacy Services
- Solicitation number
- SFGOV-0000011956
- Issued by
- California
About this file
This is a Non-Collusion Affidavit Form for a Request for Proposals issued by the San Francisco Department of Public Health (DPH) for 503A Sterile Compounding Pharmacy Services at Zuckerberg San Francisco General Hospital. The solicitation seeks qualified firms to prepare and deliver patient-specific Total Parenteral Nutrition (TPN) solutions for neonatal, pediatric, and adult patients on a continuous basis—seven days a week, 365 days per year. The RFP was published on September 8, 2026, with a pre-proposal conference scheduled for September 21, 2026, at 1:00 PM PST. The deadline for submitting questions is September 28, 2026, at 5:00 PM PST, with a Q&A addendum posting on October 5, 2026. Proposals must be submitted by October 12, 2026, at 2:00 PM PST. Short-listing notifications are estimated for November 9, 2026, with demonstrations scheduled between November 12-20, 2026, and an estimated award announcement on December 2, 2026. The contract is estimated to commence on March 1, 2027, following a Health Commission presentation in February 2027.
This Non-Collusion Affidavit form must be completed and submitted as part of Electronic File #2 by all proposers. The affidavit requires certification from a duly authorized representative confirming that the proposal is genuine, not collusive or sham, and that the proposer has not engaged in any price-fixing, coordination with other proposers, or other anticompetitive conduct. The form requires the legal name of the proposer, the authorized representative's printed name and title, date, and signature. All statements contained in the proposal must be certified as true and accurate under penalty of perjury.
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Text version
Attachment B
Non-Collusion Affidavit
Request for Proposals SFGOV-
All fields are required. This form must be completed and included with Electronic File #2.
A. 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):
Authorized Representative’s Printed Name:
Authorized Representative’s Title:
Date:
Authorized Representative’s Signature:
A. Non-Collusion Affidavit
| Legal Name of Company Proposer: |
| Authorized Representatives Printed Name: |
| Authorized Representatives Title: |
| Date: |
| Solicitation Title: 503A Sterile Compounding Pharmacy Services |
| Sourcing ID: 0000011956 |
File details come from the government source that posted it. Updated .