Attachment B Non-Collusion Affidavit Form.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 associated with a Request for Proposals issued by the San Francisco Department of Public Health to procure professional temporary radiology technologists and radiology support staff for the San Francisco Health Network. The procurement seeks qualified and experienced firms to provide credentialed and competent staff to serve multiple facilities, including Zuckerberg San Francisco General Hospital & Trauma Center, Laguna Honda Hospital, Jail Health Services, and SFHN Ambulatory Care sites. 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, with an estimated award announcement in October 2026 and a Health Commission presentation anticipated in December 2026. The estimated contract start date is January 1, 2027.
The Non-Collusion Affidavit Form requires bidders to certify under penalty of perjury that their proposal was prepared independently and without collusion, price-fixing, or any agreement with other bidders regarding pricing, terms, or conditions. This affidavit is a standard legal requirement designed to ensure fair competition and prevent anticompetitive practices among bidding contractors. All referred staff must meet the specific requirements outlined in Section 4 of the Scope of Work, and no additional pricing terms, set-asides, or funding source information is detailed in this particular form document.
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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:
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