Fillable Printable Non-Collusion Affidavit Form - Montgomery County Community College

Non-Collusion Affidavit Form - Montgomery County Community College

NON-COLLUSION AFFIDAVIT

State of :

County of :

I state that I am of

(Title) (Name of 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,

(Name of My Firm)

subsidiaries, officers, directors and employees are not currently

under investigation by any governmental agency and have not in

the last three years been convicted or found liable for any act

prohibited by State or Federal Law in any jurisdiction, involving

conspiracy or collusion with respect to bidding on any public

contract except as follows:

I state that understands

(Name of My Firm)

and acknowledges that the above representations are m aterial and important, and will be relied

on by MONTGOMERY COUNTY COMMUNITY COLLEGE in awarding the contract(s) for

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 MONTGOMERY COUNTY

COMMUNITY COLLEGE of the true facts relating to the submission of bids for this contract.

(Name)

(Company Position)

SWORN TO AND SUBSCRIBED

BEFORE ME THIS DAY

OF , 20___.

Notary Public My Commission Expires

INSTRUCTIONS FOR NON-COLLUSION AFFIDAVI T

1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this

Bid. According to Section 4507 of the Pennsylvania Commonwealth Procurement Code, 62

Pa.C.S. § 4507, governmental agencies may require Non-Collusion Affidavits to be submitted

together with bids.

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 of persons employed by or associated with the bidder with

responsibilities for the preparation, approval or submission of the bid.

4. In 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 an Affidavit in compliance with these instructions may result in

disqualification of the bid.

7. A bidder’s statement that it has been convicted or found liable for any act

prohibited by Federal or State Law in any jurisdiction involving conspiracy or collusion with

respect to bidding on any public contract within the last three (3) years does not prohibit a

government agency from accepting a bid from or awarding a contract to that bidder, but it may

be grounds for administrative suspension or debarment in the discretion of the government

agency under the rules and regulations of that agency or, in the case of a government agency

with no administrative suspension or debarment regulations or procedures, may be grounds for

consideration on the question of whether the agency should decline to award a contract to that

person on the basis of lack of responsibility.