HomeMy WebLinkAboutschedule ARFP TITLE: Purchase of Thermal Imaging Cameras RFP NO: (04)A-02
SCHEDULE "A"
CITY OF SUNRISE
NON -COLLUSION AFFIDAVIT
This affidavit is to be filled in, executed and notarized by the proposer. If the proposal is made by a
Corporation, then it should be executed by its Chief Officer. This document MUST be submitted with the
proposal.
STATE OF
)ss
COUNTY OF
,being first duly sworn, deposes and says that
(Type or print name of person who is signing below)
1. He/she is the
(Owner, Partner, Officer, Representative or Agent)
of the Proposer that has submitted the attached Proposal.
2. He/she is fully informed with respect to the preparation and contents of the attached Proposal and of all
pertinent circumstances respecting such Proposal;
3. Said proposal is made without any connection or common interest in the profits with any other persons
making any bid or proposal for the said commodities/services. Said bid is on our part in all respects fair
and without collusion or fraud. No head of any department, any employee or any officer of the City of
Sunrise is directly or indirectly interested therein. If any relatives are employed by the City, indicate
name and relationship below.
Name: Relationship:
Name: Relationship:
Company Name:
Proposer's Authorized Signature:
Subscribed and sworn to before me this day of , 20
Notary Public
(Print, Type or Stamp name of Notaty Public)
Personally known or Produced I.D.
Type and number of I.D. Produced:
Did take an oath, or Did not take an oath
14
Revised May 12, 2003