FORM 11-NON-COLLUSION CERTIFICATION.pdf

ITN No.: DMS-24/25-260 Page 1 of 2 MyFloridaNet-3 Core Services

FORM 11 – NON-COLLUSION CERTIFICATION

4050 Esplanade Way Tallahassee, FL 32399-0950

850-488-2786

Ron DeSantis, Governor Pedro Allende, Secretary

FOR

MyFloridaNetwork-3

ITN NO: DMS-24/25-260

THE STATE OF FLORIDA

DEPARTMENT OF MANAGEMENT SERVICES

ITN No.: DMS-24/25-260 Page 2 of 2 MyFloridaNet-3 Core Services

FORM 11 - NON-COLLUSION CERTIFICATION

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, directors and officers. I am the person responsible for the price(s) and amount(s) of this Response, and the preparation of this Response. I state that:

1. The price(s) and amount(s) of this Response 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 Response, and neither the approximate price(s) nor approximate amount(s) of this Response, have been disclosed to any other f irm 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 f irm or persons to ref rain from submitting a

Response for this contract, or to submit a price(s) higher that the prices in this Response, or to submit any intentionally high or noncompetitive price(s) or other form of complementary Response.

4. The Response 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 Response.

5. ______________ [name of responding organization], its af f iliates, subsidiaries, officers, director, and employees 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 further that I and the named f irm understand and acknowledge that the above representations are material and important and will be relied on by the State of Florida. 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 responses for this contract.

Dated this ____________day of ________________________, 2025.

Name of Respondent Organization:_______________________________________________

Signed by:________________________________________________ (signature)

Printed 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:___________________________________

FORM 11 - NON-COLLUSION CERTIFICATION