Non-Collusion Affidavit Form printable pdf download

City of Havre de Grace

Sewer Project - 500 Warren Street

Project #09-1232-9054

NON-COLLUSION AFFIDAVIT

State of _________________________:

County of _______________________: s.s.

I state that I am ______________________ of ________________________________________

(TITLE)

(NAME OF BIDDER’S FIRM)

and that I am authorized to make this Affidavit on behalf of my firm, and its owner, directors,

and officers. I am the person responsible in my firm for the price(s) and 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 non-competitive 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 non-competitive bid.

5) ________________________________, its affiliates, subsidiaries, officers, directors, and

(NAME OF BIDDER’S FIRM)

employees are not currently under investigation by any governmental agency and have

not in the last four 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:

NON-COLLUSION AFFADAVIT

Page NC-1

Non-Collusion Affidavit Form