Proposal Number PSDF #P09-0004
FORM OF NONCOLLUSION AFFIDAVIT
(This Affidavit is Part of BID)
STATE OF _________________________________________________
COUNTY OF _______________________________________________
_____________________________________________ being first duly sworn, deposes and says that he
is __________________________________________ (Sole owner, a partner, president, secretary, etc.)
of __________________________________________ the party making the foregoing Proposal that such
Proposal is genuine and not collusive or sham; that said VENDOR has not colluded, conspired,
connived, or agreed, directly or indirectly, with any VENDOR or person, to put in a sham
PROPOSAL, or that such other person shall refrain from bidding, and has not in any manner, directly
or indirectly sought by agreement or collusion, or communication or conference, with any person, to
fix the Proposal Price of Affiant or any other VENDOR, or to fix any overhead, profit or cost element
of said Proposal Price, or of that of any other VENDOR, or to secure any advantage against OWNER
by any person interested in the proposed Contract; and that all statements in said Proposal are true;
and further, that such VENDOR has not, directly or indirectly submitted this PROPOSAL, or the
contents thereof, or divulged information or date relative thereto to any association or to any member
or agent thereof.
___________________________
(Affiant)
Sworn to and Subscribed Before Me this _______ day of ____________________________, 20_____.
_________________________
(Notary Public)
My Commission Expires ________________________, 20 ______.
(SEAL)
B-5
