Fillable Printable Non-Collusion Affidavit Form - California

Non-Collusion Affidavit Form - California

NON-COLLUSION AFFIDAVIT

STATE OF CALIFORNIA, COUNTY OF _____________________

I, __________________________________, being first duly sworn, deposes and says that I

am the

(Typed or Printed Name)

_______________________

of _____________________________________,

(Title) (Contractor Name)

the party submitting the foregoing Bid Proposal (“the Contractor”). In connection with

the foregoing Bid Proposal, the undersigned declares, states and certifies that:

1. The Bid Proposal is not made in the interest of, or on behalf of, any undisclosed

person, partnership, company, association, organization or corporation.

2. The Bid Proposal is genuine and not collusive or sham.

3. The Contractor has not directly or indirectly induced or solicited any other

Contractor to put in a false or sham request for information, and has not

directly or indirectly colluded, conspired, connived, or agreed with any other

Contractor or anyone else to put in sham request for information, or to refrain

from submitting this Bid.

4. The Contractor has not in any manner, directly or indirectly, sought by

agreement, communication, or conference with anyone to fix the Bid price, or

that of any other Contractor, or to fix any overhead, profit or cost element of the

Bid price or that of any other Contractor, or to secure any advantage against

the public body awarding the contract or of anyone interested in the proposed

contract.

5. All statements contained in the Bid Proposal and related documents are true.

6. The Contractor has not, directly or indirectly, submitted the 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 person, corporation,

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

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

Executed this ____ day of ___________, 2011 at __

______________________________.

(City, County and State)

I declare under penalty of perjury under the laws of the State of California that the

foregoing is true and correct.

By: _________________________________ Title: _________________________

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