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

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

Non-Collusion Affidavit Form - Montgomery County Community College

Non-Collusion Affidavit Form - Montgomery County Community College

NON-COLLUSION AFFIDAVIT
State of :
SS
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:
2
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.
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