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hLO&COLU&MLAMWAYLT <br />(This 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />in accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declines <br />that flio bid Is not made In the Interest of, or on behalf of, any undisclosed person, partnembip, company, association, <br />organization, or corporation; that the bid Is genulne and not collusive or sham, that the BIDDER has not directly or <br />Indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or Indirectly <br />colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a Sham bid, or that anyone shall <br />refrain from biddlop3 that the BIDDER has not In any manner, directly or Indirectly, sought by agreement, <br />communication, or conference with anyone to fix tile bid price of the BIDDER or any BIDDER, or to flx any <br />overhead, Profit, or cost element of the bid Price, or of that of any other BIDDER, or to secure any advantage against <br />the public body awarding the contract of anyone Interested In the proposed contract; that all Statements contained in <br />the bid are true, and, further, that the BIDDER has not directly or Indirectly, Submitted his or her bid price or any <br />breakdown thorcor, or the coatonts thereof, or divulged information or data relative thereto, or paid, and will not pay, <br />any foe to any corporation, partnership, company association, organization, bid depository, or to any member or agent <br />thonsof to effectuate a collusive or sham bid. <br />Note: The above Non -collusion Affidavit Is part of the proposal. Signing flits proposal on tile signature <br />portion thereof shall also constitute Signature of this Non-collosion Affidavit. BIDDERS are cautioned that <br />making a false certification may Subject the certifier to criminal prosecution, <br />Signed ?.Rte.6112'. <br />Wry <br />State of California <br />Couniyoforange_ <br />a <br />_ <br />Subscribed and sworn to (or affirined) before me on this 20th day of h <br />MMarc 20.2015by <br />._ <br />Antonio J. Belello, proved to me 01) tile basis of Satisfactory evidence= to be the person(s) who appeared <br />61bro ­­me <br />'ANTONIO JOSi1P'H49t1!`LLj0 <br />IZ' i COMM # 2125847 <br />ORANGE, COUNIV <br />NOtARY PUBLIC -CALIFORNIA Z <br />MY COMMISSION EXPIRES <br />0E164, 2015 <br />Notary Public Scall <br />City ofSanta AnaRFP <br />Page A3.1 <br />25E-411 <br />