Attachment B Non-Collusion Affidavit Form.pdf
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- Solicitation number
- SFGOV-0000012029
- Issued by
- California
About this file
This is a Non-Collusion Affidavit form required for submission with the Department of Public Health's Request for Proposals for a Cost Accounting and Decision Support System in San Francisco, California. The RFP was published on September 8, 2026, with a pre-proposal conference scheduled for September 21, 2026, at 10:00 AM PST. The deadline for submitting questions is September 28, 2026, at 5:00 PM PST, with a Q&A addendum to be posted on October 7, 2026. Proposals must be submitted by October 19, 2026, at 2:00 PM PST. Short-listing notifications for interviews are estimated for November 16, 2026, with demonstrations tentatively scheduled between November 23 and December 11, 2026. The contract award is anticipated on December 21, 2026, with an estimated start date of May 1, 2027. The system will enable DPH to analyze its cost structure and perform detailed cost and revenue analysis.
The Non-Collusion Affidavit requires an authorized representative of the proposing organization to certify under penalty of perjury that the proposal is genuine, not collusive or sham, and has not involved any coordination with competing proposers regarding pricing, cost elements, overhead, or profit. The form mandates that all statements in the proposal are truthful and that no fees have been paid to any third party to facilitate collusion. The affidavit must be completed in full with the legal name of the company, authorized representative's printed name and title, date, and signature, and must be included with Electronic File #2 of the proposal submission. The Sourcing ID for this solicitation is 0000012029.
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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: Cost Accounting and Decision Support system |
| Sourcing ID: 0000012029 |
File details come from the government source that posted it. Updated .