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Attachment “G”
NON-COLLUSIVE AFFIDAVIT
State of
County of
Being first duly sworn, deposes and says that:
(1) He/she is of
Owner, Partner, Officer, Representative or Agent
, the Bidder that has submitted the attached bid;
Name of Company
(2) He is fully informed respecting the preparation and contents of the attached bid and all
pertinent circumstances respecting such bid;
(3) Such bid is genuine and is not a collusive sham;
(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives,
employees or parties in Interest, including this affidavit, has in any way colluded,
conspired, connived, or agreed, directly or indirectly with any other bidder, firm or
person to submit a collusive or sham bid in connection with the contract for which the
attached bid has been submitted or to refrain from bidding in connection with such
contract, or has in any manner, directly or indirectly, sought by unlawful agreement or
collusion or communication or conference with any other bidder, firm or person to fix
the price or prices in the bid price or the bid price of any other bidder, or to secure
through any collusion, conspiracy, connivance or unlawful agreement any advantage
against the Newport News Redevelopment & Housing Authority or any person
interested in the proposed contract; and
(5) The price or prices in the attached bid are fair and proper and are not tainted by any
collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or
any of its agents, representatives, owners, employees, or parties in interest, including
this affiant.
Name
Title
Subscribed and Sworn before me.
This day of , 20.
My Commission Expires
Financial Operations, IC & RA Review Initial:
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