Attachment B Non-Collusion Affidavit Form.pdf
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- Attached to
- DPH | As-Needed Radiation Safety Consulting Svc
- Solicitation number
- SFGOV-0000011986
- Issued by
- California
About this file
Summary: Attachment B Non-Collusion Affidavit Form
This is a non-collusion affidavit form for the California Department of Public Health's Request for Proposals to provide as-needed radiation safety consulting services. The form is executed by proposers in conjunction with their submissions for radiation safety officer support services, which include regulatory compliance activities, nuclear medicine program development, audits, personnel dosimetry oversight, training, documentation management, and consultation during regulatory inspections. The RFP was published on September 11, 2026, with a deadline for questions at 5:00 PM PT on September 29, 2026, and an estimated Q&A addendum posting on October 6, 2026. Proposals are due by 2:00 PM PT on October 14, 2026. A pre-proposal conference is scheduled for 11:00 AM PT on September 22, 2026, via Microsoft Teams. The estimated announcement of award is November 13, 2026, with an estimated contract start date of March 1, 2027.
The non-collusion affidavit form serves as a certification whereby proposers attest that their proposals are made independently and without collusion, fraud, or other unlawful agreement with competitors. This document is a standard requirement in competitive procurement processes to ensure fair competition and the integrity of the bidding process. The form requires authorized representatives of proposing firms to swear or affirm under penalty of perjury that no illegal agreements or understandings exist regarding pricing, proposal terms, or any other aspect of the solicitation.
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Attachment B
Non-Collusion Affidavit
Request for Proposals SFGOV-0000011986
As-Needed Radiation Safety Consulting Services
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:
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