Fillable Printable Non-Collusion Declaration - New Orleans
Fillable Printable Non-Collusion Declaration - New Orleans
Non-Collusion Declaration - New Orleans
Non-Collu si on Declaration
NON COLLUSION DECLARATION
A sworn statement shall be submitted in the form of an affidavit as indicated below, executed and sworn
to b y the bidder before persons authorize d by laws of the State to administer oaths. The original of such
sworn statement shall be submitted by the successful bidder
after
the Award of Contract.
Affidavit
State Project Number: (if applicable)
Name of Project:
______________________________________________________________________
Parish:______________________________________________________________________________
(an individual)
(a partnership)
(a corporati on)
cer tify that :
(1) That affiant employed no person, corporation, fi rm, association, or other organization, either directly or
indirectly, to secure the public contract under which he received payment, other than persons regularly
employed by the affiant whose services in connection with the construction, alteration or demolition of the
public building or project or in securing the public contract were in the regular course of their duties for
affiant, and
(2) That no part of the contract price received by affiant was paid or will be paid to any person,
corporation, firm, association, or other organization for soliciti ng the contract, other than the payment of
their normal compensation to persons regularly employed by the affiant whose services in connection
with the construction, alteration or demolition of the public building or project were in the regular course of
their duties for affiant.
(an individual)
(a partnership)
(a corporation)
WITNESSES: Signed
______________________________________
By _____ ___ ___ ___ ___ __ _______________________
Title _________________________________________
Parish or county ___ ___________________________________________________________________
State of _____________________________________________________________________________
Subscribed and sworn to before me this day of , 20 .
_________________________
NOTA RY PUBLIC (signature)
_________________________
NOTARY PUBLI C (printed nam e)
______________________ __________________
NOTARY PUBLIC NUMBER EXP IRATION DATE
