Attachment B Non-Collusion Affidavit Form.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 the Department of Public Health's Request for Proposals (SFGOV-0000011940) for Institutional Master Plan Consulting Services in California. The RFP seeks qualified and experienced firms to provide professional health planning services to support the City's review of hospital Institutional Master Plans. The pre-proposal conference is scheduled for September 18, 2026, with a deadline for questions on September 25, 2026 at 5:00 PM PT. Proposals must be submitted by October 13, 2026 at 2:00 PM PT, with an estimated announcement of award in November 2026. The estimated contract start date is June 1, 2027, with a Health Commission presentation anticipated in May 2027.
The Non-Collusion Affidavit form must be completed and submitted as part of Electronic File #2 and requires the authorized representative of the proposing firm to attest that the proposal is genuine, independent, and made without collusion, conspiracy, or coordination with any other proposer. The affidavit certifies that the proposer has not sought to fix pricing, overhead, profit, or cost elements and has not divulged proposal information or paid fees to any entity to effectuate a collusive or sham proposal. All required fields on the form, including the legal company name, authorized representative's printed name and title, date, and signature, must be completed for submission.
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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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