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tdO„ N CQUMMLA a n YiT <br />(Title 23 United States Cotte Section 112 and <br />Public CattMMI Cate Section 7106) <br />To the CITY OF SANTA ANA DP,P'ARThOM OF PUBLIC WORKS <br />In accordance with Title 23 United States Code Section 112 anal Public Contract Code 7106 the BIDDER declares <br />that the bid is not made in tic interest of, or on behalf of, any undisclosed person, partnership, company, association, <br />organization, or oorporntan; that the bid is genuine and not collusive or sham, that flie BIDDER has not directly or <br />iadheoYI Ind ph or solicited any other BIDDER Yin put lir a Elise or sham bid, and has not directly or indirectly <br />ctwArdeel, conspired, connived or agrearl rvIti any BRaDBR or anyone also to put in a sham bid, or that anyone shall <br />refrain ficin blddfng; trot tie BIDDER has not in any manger, directly or Indirectly, sought by agreement, <br />communIo floe, ar conference with anyone to Gx the bid Price of the BIDDER or any BIDDER, or to far any <br />overltoati, profit, or cost clement of the <br />bid price, or <br />of ofanyotherBIDDER, 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 />iho bid aro tragi; and, tbrther, that the BIDDER has no4 dirsoily or indirou8y, submitted his or her bid price or any <br />breakdown fbereof or the contents thereof, or divulged Information or data relative thereto, or paid, and will not pay, <br />any fee to any corporation, partnership, company association, organization, bid depository, or to silt' member or agent <br />thereof to off'octiatte a colhrsive or sham bid. <br />Note: Tile above Non -collusion Affidavit is part of the proposal. Signing this Proposal on tike signature <br />porion tier also constitute sigri.'nturo of this Non -collusion Affidavit. BIDDERS are cautioned that <br />makin girt o 'on m s trjeat oho oort[6ar to criminal prosecution, <br />Signed ,� <br />State of G <br />County of <br />Subscribed and sworn to Zr bllaed) before me on this day of 2p� by <br />proved to o ofi the basis of satisfactory evidence to be the person(sj who appeared <br />Wore mo. " th <br />SwAttsrhaar <br />Notary Puhltc Licictr went <br />Nofary Public Slgnature <br />Notary Public Seal <br />- <br />.. .. t ..._. 1. :.. .a ........ .. .. ...... i.Lc.i:\ _.fun.: ..� .�.. u..... .�L+h,.. tf f <br />25E-639 <br />