NON_COLLUSION_AFFIDAVIT.pdf

PDF 24 KB Posted

Attached to
2026 Rock Salt for Drinking Water Softening
Solicitation number
IFB-2024-027
Issued by
Hamilton County, Indiana

About this file

The document is a Non-Collusion Affidavit (State Form 4391) used in conjunction with a state and local contract opportunity for rock salt procurement by the City of Carmel, Hamilton County, Indiana. The affidavit is a standard form that requires the contracting party to swear that they have not engaged in any collusive practices or paid any undisclosed consideration for the contract, which in this case involves the procurement of approximately 12,000 tons of Coarse Southern United States Rock Salt for drinking water softening. Bids will be accepted until 9:00 am on Wednesday, August 6, 2025, through the City's e-Procurement Portal at https://procurement.opengov.com/portal/carmelin.

The rock salt must meet specific quality standards, including American Water Works Association (AWWA) specification B200-22 and NSF60 compliance, and must be clean and free of dirt and debris. The Non-Collusion Affidavit is a legal document that must be signed and notarized, affirming the bidder's integrity and lack of anti-competitive behavior in the bidding process. While the affidavit itself does not contain pricing or funding details, it is a crucial component of the procurement process that ensures fair and transparent competitive bidding for the rock salt supply contract.

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NON-COLLUSION AFFIDAVIT

State Form 4391 (R4 / 1-00)

STATE OF: ________________________________________________

COUNTY OF _______________________________________________

} SS:

The undersigned, being duly sworn on oath says, that he is the contracting party, or that he is the representative, agent, member, or officer of the contracting party, that he has not, nor has any other member, employee, representative, agent or officer of the firm, company, corporation or partnership represented by him, directly or indirectly , entered into or offered to enter into any combination, collusion or agreement to receive or pay, and that he has not received or paid, any sum of money or other consideration for the execution of the annexed contract other than that which appears upon the face of the contract.

Signature

Printed name

Title

Company

Before me, a Notary Public in and for said County and State personally appeared, ______________________________________________ , who acknowledged the truth of the statements in the foregoing affidavit on this _______________________ day of ______________________, 20 ___ .

Signature of Notary Public

Printed or typed name of Notary PublicCounty of residence Commission expiration date

state of:
county of:
signature:
title:
company:
before me:
this:
day of:
00:
county of residence:
commission expires:
printed name:
sign of notary:
printed name1:

File details come from the government source that posted it. Updated .