“[NAME OF SCHOOL DISTRICT] [NAME OF COUNTY] I, , hereby state: (1) I am the duly authorized agent of , the bidder submitting the competitive bid which is attached to this statement, for the purpose of certifying the facts pertaining to the existence of collusion among and between bidders and state officials, as well as facts pertaining to the giving or offering of things of value to government personnel in return for special consideration in the awarding of any contract pursuant to the bid to which this statement is attached
(2) I am fully aware of the facts and circumstances surrounding the making of the bid to which this statement is attached and have been personally and directly involved in the proceedings leading to the submission of the bid
(3) Neither the bidder nor anyone subject to the bidder’s direction or control has been a party: (A) To any collusion among bidders in restraint of freedom of competition by agreement to bid at a fixed price or to refrain from bidding; (B) To any collusion with any state official or employee as to quantity, quality or price in the prospective contract, or as to any other terms of the prospective contract; or (C) In any discussions between bidders and any state official concerning exchange of money or other thing of value for special consideration in the awarding of a contract
(4) I hereby guarantee that the specifications outlined in the bid shall be followed as specified and that deviations from the specifications shall occur only as part of a formal change process approved by the Board of Directors of the school district
Signature Subscribed and sworn to before me this day of , 20
Notary Public”
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