Non-Collusion_Affidavit_USDA.pdf
PDF 81 KB Posted
- Attached to
- Point-of-Sale Terminals and Peripherals
- Solicitation number
- 26048-ITB-DST
- Issued by
- Florida
About this file
This is a Non-Collusion Affidavit form required by the USDA for the Hillsborough County Public Schools' point-of-sale terminals and peripherals procurement for Student Nutrition Services. The affidavit serves as a sworn statement that must be completed and notarized by an authorized representative of the bidding vendor. The document requires the vendor to certify that the submitted proposal is genuine and has not been developed through any collusive, conspiratorial, or unlawful agreements with competing vendors or other interested parties.
The affidavit obligates the vendor to attest that neither the vendor nor any of its officers, partners, owners, agents, representatives, or employees have engaged in collusion regarding proposal submission, price-fixing, overhead or profit manipulation, or any other anticompetitive practices designed to gain unfair advantage against the school district or other interested parties. The vendor must also affirm that all quoted prices are fair, proper, and untainted by collusion or unlawful agreement. The form requires the vendor's authorized signatory to provide their name and title, along with notarization by a qualified notary public with an expiration date of their commission.
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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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