ATTACHMENT C - AFFIDAVIT OF NON-COLLUSION~1.pdf

ATTACHMENT C

AFFIDAVIT OF NON-COLLUSION/COMPLIANCE WITH TAX LAWS

Proposer:

I state that:

1. The correct taxpayer iden�fica�on numbers are:

a. Federal Employer ID Number (EIN): ___________________ b. Employer’s Oregon ID Number: _______________________

2. Proposer is not subject to backup withholding because (i) Proposer is exempt from backup withholding,

(ii) Proposer has not been no�fied by the IRS that Proposer is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has no�fied Proposer that Proposer is no longer subject to backup withholding;

3. The price(s) and amount of this Proposal must be arrived at independently and without consulta�on, communica�on or agreement with any other Supplier, Proposer or poten�al Proposer, except as disclosed on the atached appendix.

4. That neither the price(s) nor the amount of this Proposal, and neither the approximate price(s) nor approximate amount of this Proposal, will be disclosed to any other firm or person who is a Proposer or poten�al Proposer, and they will not be disclosed before Contract award.

5. No atempt has been made or will be made to induce any firm or person to refrain from proposing on this Solicita�on, or to submit any noncompe��ve Proposal or other complementary Proposal.

6. The Proposal of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Proposal.

7. ___________________________________________ (name of firm), its affiliates, subsidiaries, officers, directors and employees are not currently under inves�ga�on by any governmental agency and have not in the last four years been convicted of or found liable for any act prohibited by State or Federal law in any jurisdic�on, involving conspiracy or collusion with respect to proposing on any public contract, except as described in the atached appendix.

I state that ___________________________________________ (name of firm) understands and acknowledges that the above representa�ons are material and important, and will be relied on by the Oregon Child Development Coali�on in awarding the contract(s) for which this Proposal is submited. I understand and my firm understands that any misstatement in this affidavit is and will be treated as fraudulent concealment from the Oregon Child Development Coali�on of the true facts rela�ng to the submission of Proposals for this contract.

I am authorized to act on behalf of Proposer, and have authority and knowledge regarding Proposer's payment of taxes, and to the best of my knowledge, Proposer is not in viola�on of any Oregon tax laws, including, without limitation, those tax laws listed in ORS 305.380(4), the elderly rental assistance program under ORS

310.630 to 310.706; and any local taxes administered by the Oregon Department of Revenue under ORS 305.620.

Affiant’s Signature: _________________________________

STATE OF OREGON County of: _________________________________

Signed and sworn to before me on: _______________________________ by

(date) (Affi ant' s name)

Notary: __________________________________________

My Commission Expires: ______________________________