Fillable Printable Non-Collusion Affidavit - California

Non-Collusion Affidavit - California

PROJECT TITLE

Project No.

00 45 19 - 1 Non-Collusion Affidavit

DOCUMENT 00 45 19

NON-COLLUSION AFFIDAVIT

Public Contract Code §7106

NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED

WITH BID

STATE OF CALIFORNIA )

) ss.

COUNTY OF )

, being first duly sworn,

(Name of Principal of Bidder)

deposes and says that he or she is

(Office of Affiant)

of , the party

(Name of Bidder)

making the foregoing Bid, that the Bid is not made in the interest of, or on behalf of, any

undisclosed person, partnership, company, association, organization, or corporation; that

the Bid is genuine and not collusive or sham; that Bidder has not directly or indirectly

induced or solicited any other bidder to put in a false or sham Bid, and has not directly or

indirectly colluded, conspired, connived or agreed with any bidder or anyone else to put in

a sham Bid, or that anyone shall refrain from bidding, and that the Bidder has not in any

manner, directly or indirectly, sought by agreement, communication or conference with

anyone to fix the Bid price of 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, or to secure any advantage

against the City of San Bruno, or anyone interested in the proposed contract; that all

statements contained in the Bid are true; and further, that Bidder has not, directly or

indirectly, submitted its Bid price or any breakdown thereof, or the contents thereof, or

divulged information or data relative thereto, or paid, and will not pay, any fee to any

corporation, partnership, company association, organization, Bid depository, or to any

member or agent thereof to effectuate a collusive or sham Bid.

PROJECT TITLE

Project No.

Non-Collusion Affidavit 00 45 19 - 2

Executed under penalty of perjury under the laws of the State of California:

(Name of Bidder)

(Signature of Principal)

Subscribed and sworn before me

This day of __________________, 20

Notary Public of the State of

In and for the County of

My Commission expires (Seal)

NOTE: If Bidder is a partnership or a joint venture, this affidavit must be signed and

sworn to by every member of the partnership or venture.

NOTE: If Bidder [including any partner or venturer of a partnership or joint venture]

is a corporation, this affidavit must be signed by the Chairman, President, or

Vice President and by the Secretary, Assistant Secretary, Chief Financial

Officer, or Assistant Treasurer.

NOTE: If Bidder’s affidavit on this form is made outside the State of California, the

official position of the person taking such affidavit shall be certified

according to law.

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