Non_Collusion_Affidavit.cleaned.pdf
PDF 74 KB Posted
- Attached to
- LIME SLAKER REPLACEMENT PROJECT
- Solicitation number
- RFQ/P NO. 3095
- Issued by
- Santa Barbara County, Los Angeles City, California
About this file
This is a Non-Collusion Affidavit form issued by the City of Lompoc Purchasing Department for the Lime Slaker Replacement Project. The affidavit requires an authorized representative of the bidding company to certify under penalty of perjury that the submitted bid is genuine and not collusive, and that no collusion, conspiracy, or agreement exists between the bidder and any other bidder, firm, or person regarding bid submission or the restraint of competition. The affidavit further requires certification that no fees, commissions, gifts, or other consideration have been or will be exchanged in connection with collusion or restraint of competition, and that the bidder has not disclosed its bid price or terms to any other bidder or potential bidder prior to the official bid opening. The project involves the upgrade of two lime slaker units at the City's Water Treatment Plant located at 601 East North Avenue, with proposals due by 2:00 pm on Thursday, April 30, 2026. Proposals must be submitted to Theresa Hernandez, Senior Buyer, at the City of Lompoc Purchasing Division, 100 Civic Center Plaza, Lompoc, California 93436, in the form of one original with original signatures, three copies, a thumb drive, and an upload to the OpenGov project site.
The affidavit must be completed and signed by an authorized company representative with their printed name, title, and date. Notarization may be required depending on the City's specific requirements. Proposed fees must be submitted in a separate sealed envelope and are not to be included on the thumb drive or uploaded to OpenGov. All proposals are valid for 90 calendar days after the bid opening date. Proposers must complete and return the Registered Proposer Information Sheet prior to proposal submission to ensure they receive notice of any changes to the solicitation. The City reserves the right to reject any submission from proposers found to be in violation of communication restrictions regarding this solicitation.
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Text version
Non-Collusion Affidavit
City of Lompoc, Purchasing Department, 100 Civic Center Plaza, Lompoc, CA 93436 (805)875-8000 fax (805)875-8633 purchasing@ci.lompoc.ca.us
To: City of Lompoc – Purchasing Department
From:
Project Name: __________________________________________
Solicitation Number: _____________________________________
Bidder/Company Name: ___________________________________
Business Address: _______________________________________
City, State, ZIP: _________________________________________
AFFIDAVIT
I, ______________________________________, (Name of authorized representative) being duly sworn, depose and say that:
1. I am the ____________________________ of the above-named company, (Title or Position) and am authorized to make this affidavit on its behalf.
2. The bid submitted for the above-referenced project is genuine and not a sham or collusive.
3. Neither the bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest has colluded, conspired, or agreed—directly or indirectly—with any other bidder, firm, or person to submit a sham bid or to refrain from bidding.
4. No person or entity has received or will receive any fee, commission, gift, or other consideration in exchange for collusion or restraint of competition.
5. The bidder has not disclosed its bid price or terms to any other bidder or potential bidder prior to the official bid opening.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signature: __________________________________________
Printed Name: _______________________________________
Title: _______________________________________________
Date: _______________________________________________
Notary Public Signature (if required): ______________________
Commission Number: _________________________________
Expiration Date: _______________________________________
File details come from the government source that posted it. Updated .