Non-Collusion_Affidavit_USDA.pdf
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- Solicitation number
- 25533-RFP-DST
- Issued by
- Florida
About this file
This is a Non-Collusion Affidavit required by the United States Department of Agriculture (USDA) for the State of Florida, specifically for Hillsborough County Public Schools (HCPS) Student Nutrition Services (SNS). The affidavit is a sworn statement executed before a notary public in which a vendor certifies that it has prepared its proposal in good faith without any collusive or sham elements. The vendor represents that neither it nor any of its officers, partners, owners, agents, representatives, or employees have engaged in any form of collusion, conspiracy, or unlawful agreement with other vendors regarding proposal submission, pricing, overhead, profit, or cost elements for the paper products contract.
The affidavit requires the vendor to affirm that the prices quoted are fair, proper, and untainted by any collusive or unlawful agreement. The document must be completed with the vendor's name and authorized representative's signature, along with the date of execution and notary certification. This affidavit is a standard compliance requirement for USDA-funded programs under the National School Breakfast and National School Lunch programs and must be submitted as part of the vendor's proposal for the annual paper products delivery contract to approximately 219 HCPS school sites.
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Text version
Rev. May 2021
NON-COLLUSION AFFIDAVIT
STATE OF FLORIDA
COUNTY OF ______________________
_______________________________________ (VENDOR) being first duly sworn, deposes, and says that:
(FSMC Official)
VENDOR is the ____________________________________ of _____________________________________, (Owner, Partner, Officer, Representative, Agent) (Vendor)
VENDOR is fully informed respecting the preparation and contents of the attached proposal and of all pertinent circumstances respecting such proposal;
Such proposal is genuine and is not a collusive or sham proposal;
Neither the said VENDOR nor any of its officers, partners, owners, agents, representative, employees or parties in interest, including this affidavit, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other VENDOR, firm or person to submit a collusive or sham proposal in connection with the contract for which the attached proposal has been submitted; or to refrain from proposing in connection with such contract; or have in any manner, directly or indirectly, sought by agreement or collusion, or communications, or conference with any VENDOR, firm, or person to fix the price or prices in the attached proposal or any other VENDOR, or to fix any overhead, profit, or cost element of the proposal price or the proposal price of any other VENDOR, or to secure through any collusion conspiracy, connivance, or unlawful agreement any advantage against the SFA, or any person interested in the proposed contract;
The price of items quoted in the attached proposal are fair and proper and are not tainted by collusion, conspiracy, connivance, or unlawful agreement on the part of the VENDOR or any of its agents, representatives, owners, employees, or parties in interest, including this affidavit.
By _______________________________
Subscribed and sworn to before me this _____ day of _________________________, 20____.
Notary Public (Signature)
My Commission Expires:
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