Non-Collusion Affidavit.docx
DOCX document 157 KB Posted
- Solicitation number
- 2136958
- Issued by
- Erie County, New York
About this file
This is a Non-Collusion Affidavit form for Roswell Park Comprehensive Cancer Center in New York related to a Request for Proposals (RFP) seeking a single, integrated revenue integrity and patient financial software platform. The RFP solicits qualified vendors to provide automated, auditable workflows across multiple hospital revenue cycle functions, including underpayment reporting and recovery, payer contract management and performance analytics, patient financial estimates and assistance workflows, and eligibility verification with coverage discovery. Roswell Park seeks a vendor capable of demonstrating automation, data integration, audit readiness, and measurable financial impact with minimal manual processes, with a strong preference for a single-vendor platform delivered under one agreement with integrated implementation and support. The affidavit must be signed and submitted as part of the bidder's proposal response, with specific reference fields for the RFP number, title, and date to be completed by each bidding organization.
The Non-Collusion Affidavit requires bidders to certify that their pricing and bid responses were developed independently without consultation, communication, collusion, or agreement with other bidders or potential bidders. Bidders must warrant that they have not attempted to induce other companies to refrain from bidding, submit non-competitive pricing, or provide complementary offers, and that neither they nor their affiliates, subsidiaries, officers, directors, or employees are currently under investigation or have been convicted in the past four years for acts involving bidding conspiracy or collusion. Additionally, bidders must certify that no gifts, commissions, or items of value have been or will be provided to Roswell Park or other bidders in connection with the RFP. Misstatements in the affidavit are treated as fraudulent concealment, and the representations are material to Roswell Park's contract award decision. No MWBE contracting goals have been established for this procurement.
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| File | Type | Posted |
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| Disclosure Form.docx | DOCX document | |
| EEO Policy Statement.docx | DOCX document | |
| eo-16 certification.pdf | ||
| RFP 27-03 Extension Addendum 1 FINAL.docx | DOCX document | |
| Roswell Park_Business Asscociate Agreement (v. 09.2025).docx | DOCX document | |
| RFP 27-03 QA Addendum 3 FINAL.docx | DOCX document | |
| Template_Appendix C (Information & System Security Reqs)_10.2025.docx | DOCX document | |
| Appendix A Roswell Park Required Clauses (v.12.2025-1).docx | DOCX document | |
| Appendix B - Roswell Park Terms and Conditions (v 02.2025).docx | DOCX document | |
| EEO Staffing Plan.docx | DOCX document | |
| RFP 27-03 Extension Addendum 2 FINAL.docx | DOCX document | |
| RFP 27-03 Scope of Work FINAL.docx | DOCX document | |
| RFP 27-03 Clarification Addendum 4 FINAL.docx | DOCX document | |
| Appendix A-1 EEO Requirements (v.12.2025-1).docx | DOCX document |
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Text version
NON-COLLUSION AFFIDAVIT
| Request for Proposal Number: |
| Click here to enter text. |
| Request for Proposal Title: |
| Title of RFP |
| Request for Proposal Date: |
| Click here to enter a date. |
Pursuant to the above referenced Roswell Park Comprehensive Cancer Center (“Roswell Park”) Request for Proposal (the “RFP”), the bidder identified on the last page of this Non-Collusion Affidavit (the “Bidder”) certifies that:
1. The pricing and Bid Response submitted by the Bidder has been arrived at independently and without consultation, communication, collusion, and/or agreement with any other company and/or person who is a bidder and/or potential bidder on the RFP, and has not been disclosed to any other company and/or person who is a bidder and/or potential bidder on the RFP, and will not be disclosed to any company and/or person who is a bidder and/or potential bidder on the RFP before the opening of the Bid Responses by Roswell Park;
2. No attempt has been made and/or will be made by the Bidder to induce any company and/or person to refrain from bidding on the RFP;
3. No attempt has been made and/or will be made by the Bidder to induce any other company and/or person who is a bidder and/or potential bidder on the RFP to submit any intentionally high and/or noncompetitive pricing and/or Bid Response;
4. The Bidder’s Bid Response is made in good faith and not pursuant to any agreement and/or discussion with any other company and/or person and/or inducement from any company and/or person to submit a complementary offer;
5. The Bidder, including its affiliates, subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency for any act prohibited by State and/or Federal law in any jurisdiction involving conspiracy and/or collusion with respect to bidding on any public contract, and have not, in the last four (4) years, been convicted of and/or found liable for any act prohibited by State and/or Federal law in any jurisdiction involving conspiracy and/or collusion with respect to bidding on any public contract; and
6. Neither Roswell Park nor any other company and/or person (including any company and/or person who is a bidder and/or potential bidder on this RFP) has, have, and/or will receive from the Bidder, either directly or indirectly, any gifts, commissions, and/or similar items of value in connection with this RFP.
Any defined terms in the RFP shall have the same respective meanings in this Non-Collusion Affidavit. The Bidder hereby warrants that by signing this Non-Collusion Affidavit, it is certifying that the above statements are true and accurate as they relate to the Bidder as of the date in which this Non-Collusion Affidavit is signed by the Bidder as indicated below. The Bidder understands and acknowledges that the above representations are material and important, and will be relied on by Roswell Park in awarding a Resultant Agreement. The Bidder understands and acknowledges that any misstatement in this Non-Collusion Affidavit is and shall be treated as fraudulent concealment from Roswell Park of the true facts relating to the submission of the Bidder’s Bid Response.
(Bidder)
Signature
Printed Name
Title
Date
| Rev. August 2015 |
| Page 1 of 2 |
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