Non-Collusion_Declaration.pdf
PDF 281 KB Posted
- Attached to
- 26LS0005 - Temporary Relief Physician Services
- Solicitation number
- 0000039962
- Issued by
- Los Angeles County, California
About this file
This is a Non-Collusion Declaration form required by the State of California Department of Veterans Affairs for solicitation number 26LS0005, which concerns temporary relief physician services at the Veterans Home of California in Lancaster. The declaration serves as a certification document that bidders must complete and submit as part of their proposal. The form requires the bidder's authorized representative to affirm that the bid is genuine, independently prepared, and free from any collusive arrangements with other bidders or parties.
The declarant must attest under penalty of perjury that no communication, agreement, or coordination has occurred regarding bid pricing, cost elements, or bid contents with any other entity. The signatory must confirm full authority to execute the declaration on behalf of the bidding entity, whether it is a corporation, partnership, joint venture, limited liability company, or other organizational structure. The completed declaration must be dated and executed in a California city, with the signature of an authorized company representative required for submission with the bid package.
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Text version
State of California Solicitation Number: 26LS0005 Department of Veterans Affairs
NON-COLLUSION DECLARATION
The undersigned declares:
I am the of (Bidder), the party making the foregoing
(Title) (Name of Bidder) bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The Bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The Bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of the Bidder, if the Bidder is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on , at , California.
(Date) (City)
Company Representative Signature
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