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hLO&COL U&MLAM WAYLT <br />(This 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANrA 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 'lot collusive or sham, that Vic 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 Say <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-colluslon Affidavit Is part of the proposal, Signing flits proposal on tile sigindom <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 ?. .6112'. <br />State of California <br />Couniyof_QLan a <br />L_ <br />Subscribed and swom to (or affirined) before me on this 20th day of Marc 20.LS by <br />.M_ h <br />Antonio J. Belello proved to me 01) tile basis of Satisfactory e�d�= to be the person(s) who appeared <br />61bro ­­me� <br />'A'NTON10 JOSi1P'H49t1!`LLj0 <br />I COMM # 2125847 <br />Z' i <br />ORANGE, COUNIV <br />NOtARY PUBLIC-CALIFORNIA Z <br />MY COMMISSION EXPIRE$ <br />0 1 R 02 �4, 2 0 15 <br />Notary Public f call <br />City 4-5rits -AnaRrP <br />Page A3.1 <br />25E-411 <br />