Form D - Non-Collusion Affidavit For ContractorFORM D
NON COLLUSION AFFIDAVIT FOR CONTRACTOR
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
_____________________________________________________ declares and says:
1. That he/she is the (owner, partner, representative, or agent)
of _______________________________________________, hereinafter referred to as (CONTRACTOR) or (subcontractor).
2. That he/she is fully informed regarding the preparation and contents of this proposal for certain work in the City of Rosemead, State of California.
3. That his/her proposal is genuine, and is not collusive or a sham proposal.
4. That any of its officers, owners, agents, representatives, employees, or parties in interest, including this affiliate, has not in any way colluded, conspired, connived or agreed,
directly or indirectly, with any other CONTRACTOR, firm, or person to submit a collusive or sham proposal in connection with such contract, or to refrain to submitting a proposal in
connection with such contract, or has in any manner, directly or indirectly, sought by unlawful agreement or connivance with any other CONTRACTOR, firm, or person to fix the price or
prices in said proposal, or to secure through collusion, conspiracy, connivance, or unlawful agreement any advantage against City, or any person interested in the proposed contract;
and,
5. That the price or prices quoted in the proposal are fair and proper, and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the CONTRACTOR,
or any of its agents, owners, representatives, employees, or parties in interest, including this affiliate.
I certify (or declare) under penalty of perjury, that the foregoing is true and correct.
Dated this ______ day of ________, 2020, at___________________, California.
Signed: ____________________________
Title: ____________________________