HomeMy WebLinkAboutATTACHMENT 4
ATTACHMENT 4
NON-COLLUSION AFFIDAVIT FORM
Must be executed by proposer and submitted with the proposal
I, ________________________________________ (name) hereby declare as follows:
I am _________________________________ of ______________________________,
(Title) (Company)
the party making the foregoing proposal, that the proposal is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine
and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other proposer
to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with
any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that the
proposer has not in any manner, directly or indirectly, sought by agreement, communication, or conference with
anyone to fix the proposal price of the proposer or any other proposer, or to fix any overhead, profit, or cost
element of the proposal price, or of that of any other proposer, or to secure any advantage against the public
body awarding the agreement of anyone interested in the proposed agreement; that all statements contained in
the proposal are true; and, further, that the proposer has not, directly or indirectly, submitted his or her proposal
price or any breakdown thereof, or the contents thereof, or divulged information or data relative hereto, or paid,
and will not pay, any fee to any corporation, partnership, company, association, organization, proposal depository,
or to any member or agent thereof to effectuate a collusive or sham proposal.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Proposer Signature: __________________________________________________
Proposer Name: __________________________________________________
Proposer Title: __________________________________________________
Company Name: __________________________________________________
Address: __________________________________________________