USDA_Non-Collusion_Affidavit.pdf
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- Solicitation number
- 018-RW-0926
- Issued by
- Polk County, Florida
About this file
This is a Non-Collusion Affidavit form published by the U.S. Department of Agriculture (USDA) for use by state and local agencies, school boards, and school food authorities in procurement activities. The affidavit is designed to be executed by bidders on contracts valued at $25,000 or more annually and serves as a certification requirement for responsive bids. The form requires completion by the firm member, officer, or employee with final decision-making authority over pricing. For joint ventures, each party must submit a separate affidavit. The affidavit is material to contract awards and failure to file it in compliance with instructions may result in bid disqualification.
The affidavit requires the signatory to attest under oath that bid prices were determined independently without consultation or communication with other bidders, that pricing information was not disclosed to competing firms prior to bid opening, that no attempt was made to influence other bidders to refrain from bidding or submit non-competitive bids, and that the bid is submitted in good faith. The form also requires disclosure of any government investigations or convictions related to bid collusion or conspiracy within the preceding three years. The affidavit must be notarized and is intended to protect agencies from antitrust violations such as bid rigging, price fixing, and market allocation schemes. Misstatements in the affidavit are treated as fraudulent concealment and may subject bidders to criminal prosecution.
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INSTRUCTIONS AND INFORMATION CONCERNING THIS AFFIDAVIT
This NON-COLLUSION AFFIDAVIT was published in the Partnership in Purchasing Issue No. 37, dated Winter 1994-95 by the South Eastern Regional Office (SERO) of the USDA. National School Lunch and Breakfast Sponsors are encouraged to use this form on Bids and contracts for $25,000 or more per year. Each State Agency, School Board or School Food Authority (SFA) may elect to require the use of this certification as part of a responsive bid or contract at their discretion.
This document is designed to protect State and local agencies from becoming targets of antitrust violations such as bid rigging schemes, price fixing agreements and market or customer allocations.
If a bidder signing the affidavit is ever found guilty of unlawful procurement or antitrust activities, these documents can and will be made available to Federal or State Agency officials in taking appropriate criminal and/or civil actions against said bidders.
1. This non-collusion affidavit is material to any contract awarded pursuant to this bid.
2. This non-collusion affidavit must be executed by the member, officer or employee of the bidder who makes the final decision on prices and the amount quoted in the bid.
3. Bid rigging and other efforts to restrain competition, and the making of false sworn statements in connection with the submission of bids are unlawful and may be subject to criminal prosecution. The person who signs the affidavit should examine it carefully before signing and assure himself or herself that each statement is true and accurate, making diligent inquiry, as necessary, of all other persons employed by or associated with the bidder with responsibilities for the preparation, approval or submission of the bid.
4. In the case of a bid submitted by a joint venture, each party to the venture must be identified in the bid documents, and an affidavit must be submitted separately on behalf of each party.
5. The term “complementary bid” as used in the affidavit has the meaning commonly associated with that term in the bidding process, and includes the knowing submission of bids higher than the bid of another firm, any intentionally high or noncompetitive bid, and any other form of bid submitted for the purpose of giving a false appearance of competition.
6. Failure to file this affidavit in compliance with these instructions, when required, may result in disqualification of the bid.
USDA NON-COLLUSION AFFIDAVIT
State of : Contract or Bid No.
{County} I state that I am of {Person’s Title} {Name of this firm} And that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers. I am the person responsible in my firm for the price(s) and the amount of this bid.
I state that: (1) the price(s) and amount of this bid have been arrived at independently and without consultation, communication or agreement with any other contractor, bidder, or potential bidder.
(2) Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor approximate amount of this bid, have been disclosed to any other firm or person who is a bidder or potential bidder, and they will not be disclosed before bid opening.
(3) No attempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or noncompetitive bid or other form of complementary bid.
(4) The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive bid.
(5) , its affiliates, subsidiaries, {Name of My Firm} officers, directors and employees are not currently under investigation by any government agency and have not in the last three years been convicted or found liable for any act prohibited by State or Federal law I any jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract, except as follows:
I state that understands and acknowledges {Name of my Firm} that the above representations are material and important, and will be relied upon by in awarding the contract(s) for {Name of Public Entity} which this bid is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from
{Name of Public Entity} of the true facts relating to submission of bids for this contract(s).
{Name of Company Official} / {Position} / {Date}
SWORN TO AND SUBSCRIBED
BEFORE ME THIS DAY
{NOTARY PUBLIC}
OF , 20 My Commission Expires:
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