Conflict of Interest and Non-Collusion Affidavit.PDF
PDF 708 KB Posted
- Attached to
- Fall Protection Equipment
- Solicitation number
- RFB-B-25-26-02-0-2026/JS
- Issued by
- Florence County, Wisconsin
About this file
This document is a Conflict of Interest and Non-Collusion Affidavit for Chippewa Valley Technical College (CVTC), located in Wisconsin. The related state and local contract opportunity involves a request for fall protection equipment to be used in CVTC's Safety Education Center at 2322 Alpine Road in Eau Claire, WI. The vendor will be responsible for equipment delivery, warranty coverage, and handling any potential warranty claims with distributors or manufacturers.
The procurement allows for alternate/equivalent equipment, with CVTC reserving the sole right to judge equivalency. Vendors must submit an itemized comparison documenting differences if proposing alternatives to the specified manufacturer brands or part numbers. The solicitation emphasizes that the specified brands define minimum quality and performance standards, and are not intended to limit competition. Vendors must comply with non-collusion statutes, disclose any potential conflicts of interest, and understand that false statements could be punishable as perjury under Wisconsin state law.
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Other files
| File | Type | Posted |
|---|---|---|
| Business Contact Information.PDF | ||
| Verification of Understanding & Submission Acknowledgement.PDF | ||
| Cost Proposal.XLSX | XLSX spreadsheet | |
| RFB# B-25-26-02.PDF | ||
| Cooperative Purchasing Agreement.PDF | ||
| RFB Specifications.PDF |
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Text version
Document Tracking No. PG-APR-200-005
CONFLICT OF INTEREST AND NON-COLLUSION AFFIDAVIT FORM
I. Affiant's Information
• Name: ________________________________________________
• Title/Position: __________________________________________
• Company/Organization: _______________________________
• Address: _______________________________________________
• City, State, ZIP Code: ___________________________________
• Phone Number: ________________________________________
• Email Address: _________________________________________
II. Conflict of Interest Certification I, _____________________, hereby certify that I have no conflict of interest in connection with this official request for bid or proposal from Chippewa Valley Technical College. Furthermore, I certify that:
• I understand that a conflict of interest occurs when personal interests, relationships, or activities influence or appear to influence our ability to act in the best interests of our company.
• I will disclose any potential conflicts of interest that may arise from our business relationship with Chippewa Valley Technical College for the entire term of this request for bid or proposal contract term.
• I will immediately notify Jody Schneider, District Purchasing Coordinator at Chippewa Valley Technical College at proposalsubmission@cvtc.edu, in the event that any potential conflict of interest arises prior to, or any time during our business relationship.
III. Non-Collusion Certification I, _____________________, hereby certify that I am in compliance with Chapter 946.13 of the Wisconsin State Statues in the matter of private interest in public contracts:
• I have not directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with this official request for bid or proposal for Chippewa Valley Technical College.
• Neither I nor any of my employees, agents, or representatives have disclosed the terms of my bid or proposal to any other bidder or potential bidder prior to the official opening of the bids or proposals.
• I have not in any manner sought by collusion, agreement, or otherwise to influence any aspect of the official request for bid or proposal selection process.
IV. Acknowledgment I acknowledge that this affidavit is made under oath and that any false statement made herein is punishable as perjury under the laws of the State of Wisconsin.
Affiant's Signature: _______________________________ Date: __________________
Notary Public Subscribed and sworn to before me this ______ day of ______________, 20____.
Signature of Notary Public: ___________________________
Notary Public, in and for the County of ______________, State of ______________.
My Commission Expires: ___________________________.
mailto:proposalsubmission@cvtc.edu
| I. Affiant's Information |
| II. Conflict of Interest Certification |
| III. Non-Collusion Certification |
| IV. Acknowledgment |
| Notary Public |
| TitlePosition: |
| CompanyOrganization: |
| Address: |
| City State ZIP Code: |
| Phone Number: |
| Email Address: |
| Name: |
File details come from the government source that posted it. Updated .