NGFW_AFFIDAVIT_NONCOLLUSION2.pdf
PDF 107 KB Posted
- Attached to
- 4618-20260930092701 Hattiesburg
- Solicitation number
- 3170036788
- Issued by
- Mississippi
About this file
This is an Affidavit of Non-Collusion form required as an attachment to a bid submission for Hattiesburg Clinic, P.A.'s NGFW Perimeter Defense Refresh project involving high-availability firewall replacement in Mississippi. The affidavit must be completed and notarized by an authorized representative of the bidding firm prior to bid submission. The form requires the affiant to certify that bid pricing was developed independently without consultation or communication with competing bidders, that pricing has not been disclosed to competitors prior to bid opening, and that no attempts have been made to induce other firms to refrain from bidding or submit noncompetitive bids.
The affidavit includes certifications affirming that the bid is submitted in good faith and not pursuant to any collusive agreement, and requires disclosure of any investigation or conviction of the bidding firm, its affiliates, subsidiaries, officers, directors, or employees by governmental agencies within the past four years related to collusion or bid-rigging on public or grant-funded contracts. The form emphasizes that misstatements constitute fraudulent concealment of material facts and may result in bid rejection, contract termination, and referral to appropriate authorities. Bid Number 4618-20260930092701 is associated with this solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| NGFW_PRICING_FILLABLEFORM3.pdf | ||
| 4618-20260930092701 HATTIESBURG CLINIC.pdf |
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Text version
Hattiesburg Clinic | Agency Bid Bank Solicitation Attachment
Affidavit of Non-Collusion
NGFW Perimeter Defense Refresh — High-Availability Firewall Replacement
Hattiesburg Clinic, P.A. | Bid Number: 4618-20260930092701
State of: ________________________________________
County of: ________________________________________
BEFORE ME, the undersigned authority, personally appeared the affiant identified below, who, being first duly sworn, deposes and states as follows:
Affiant Name: _____________________________________________
Title / Position: _____________________________________________
Bidding Firm Name: _____________________________________________
I am authorized to make this affidavit on behalf of the above-named firm, its owners, directors, and officers, and I am the person responsible within my firm for the price(s) and amount of the bid submitted in response to the above-referenced solicitation.
Certifications
1. The price(s) and amount of this bid have been arrived at independently, without consultation, communication, or agreement with any other bidder, competitor, or potential bidder for the purpose of restricting competition.
2. Neither the price(s) nor the amount of this bid, nor any approximation thereof, has been knowingly disclosed by the bidder, directly or indirectly, to any other bidder or competitor prior to bid opening, and will not be so disclosed before bid opening.
3. No attempt has been made, and none will be made, by the bidder to induce any other firm or person to refrain from bidding on this contract, to submit a bid higher than this bid, or to submit any intentionally noncompetitive or complementary bid.
4. This bid 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 noncompetitive bid.
5. The bidding firm, its affiliates, subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency, and have not, within the last four (4) years, been convicted of or found liable for any act prohibited by state or federal law involving collusion or bid-rigging with respect to any public or grant-funded contract, except as disclosed below:
Disclosures (if none, write “None”):
I understand and acknowledge that the foregoing representations are material and will be relied upon by Hattiesburg Clinic, P.A. in evaluating and awarding this contract. I further understand that any misstatement in this affidavit shall be treated as fraudulent concealment of material facts and may result in rejection of this bid, termination of any resulting contract, and referral to appropriate authorities.
Signature: ______________________________________ Date: _______________
Printed Name / Title: ______________________________________________________
Notary Acknowledgment
Sworn to and subscribed before me this _____ day of ____________________, 20____.
Hattiesburg Clinic | Agency Bid Bank Solicitation Attachment
Notary Public Signature: ______________________________________
My Commission Expires: ______________________
[Notary Seal]
| Certifications |
| Notary Acknowledgment |
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