Attachment J Non Collusion Affidavit.docx
DOCX document 28 KB Posted
- Attached to
- Senior Community Service Employement Program
- Solicitation number
- RFP-11545
- Issued by
- Leon County, Florida
About this file
This document is a Non-Collusion Affidavit (Attachment J) required by the Florida Department of Elder Affairs (DOEA) for solicitation number 24-RFP-001-JT. The affidavit is a legally binding document that must be completed, signed, and notarized by authorized representatives of firms submitting proposals for the Senior Community Service Employment Program (SCSEP) contract.
The affidavit requires bidders to certify that their proposal prices and amounts were determined independently without consultation or agreement with other providers, that pricing information has not been disclosed to other potential providers, and that no attempts have been made to induce others to refrain from bidding or to submit complementary bids. Firms must also declare that neither they nor their affiliates have been convicted of bid-related crimes in the past three years. The document must be notarized and dated in 2025, indicating this is for an upcoming procurement cycle.
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Text version
ATTACHMENT J
NON-COLLUSION AFFIDAVIT
| STATE OF | COUNTY OF | |||
| I state that I | of | , (Name and Title) | (Name of Firm) |
am authorized to make this affidavit on behalf of my firm and its owner(s), directors, and officers. I am the person responsible in my firm for the price(s) and amount(s) of this Proposal, and the preparation of the Proposal. I state that:
| 1. | The price(s) and amount(s) of this Proposal have been arrived at independently and without consultation, communication, or agreement with any other Provider, potential provider, Proposal, or potential Proposal. |
| 2 | Neither the price(s) nor the amount(s) of this Proposal, and neither the approximate price(s) nor approximate amount(s) of this Proposal, have been disclosed to any other firm or person who is a Provider, potential Provider, Proposal, or potential Proposal, and they will not be disclosed before Proposal opening. |
3. No attempt has been made or will be made to induce any firm or persons to refrain from submitting a Proposal for this contract, or to submit a price(s) higher than the prices in this Proposal, or to submit any intentionally high or noncompetitive price(s) or other form of complementary Proposal.
4. 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.
5. , its affiliates, subsidiaries, officers, director, and employees (Name of Firm) are not currently under investigation by any governmental agency and have not in the last three years been convicted or found liable for any act prohibited by state or federal law in any jurisdiction involving conspiracy or collusion with respect to Proposal on any public contract, except as follows:
I state that I and the named firm understand and acknowledge that the above representations are material and important and will be relied on by the State of Florida for which this Proposal is submitted. I understand, and my firm understands that any misstatement in this affidavit is, and shall be treated as, fraudulent concealment from the State of Florida of the true facts relating to the submission of Proposals for this contract.
Dated this day of 2025.
Name of Organization: Signed by:
Print Name being duly sworn deposes and says that the information herein is true and sufficiently complete so as not to be misleading.
Subscribed and sworn before me this day of 2025.
Notary Public:
My Commission Expires:
DOEA Solicitation No.: 24-RFP-001- JT Page 1 of 1
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