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19 hdow sulti; <br />U M <br />(Tit aflon 112 mid <br />public contract aodic section 7106) <br />TO the Cl Ty Or SAM ANA DBPAWrMMT Op PLMLIC WORKS <br />in flocardan't with T"b` 23 Unlicul Slide$ Code Stedna 112 and Public Contract Code 7106 tire BIDDER de4am <br />that ft bid Is nou mada in dro Inhuarg a& or on behatirif, any undisclosed person, parlainsid , c upoi " ass I I <br />orsonization. of corporation; that the bid is flemalm AM not criffirsIVO Of STIAM; that flut DID p or III cc in Off <br />DER has not directly or <br />Indirectly Indumd of solicited any other BIDDER loput in a f1da, a short K and has not directly <br />c0findixt, ITHISPlard. matrived Or agreed with any BIDDER of anyone also to Put In a Aturn bid, or that <br />whill ban ldIddhW that the BIMMt has 11% 10 Any Orammur, dhecd Or IndbOVOY, Sought by affarenrout, <br />counalluillemort, or conference with prom to fix do' bid PdCO Or the BIDER Of any BIDDER, or to fix ally <br />Overhand' padd- or Cost O'c"On't of the ffid Priet, " OFOW Of PAY Other DIDDER, or to seetax any <br />flit public body awarding fix contract of anyone bruncered in he ad Unit Oil stAhniftents contained in <br />flit bid One truel and, fluflurr, that the 13 IDDER has mf� directV onj I()H0FSmICY0' atumbfil;jff his or her bid prko or any <br />breakdown thernar, or the contents therong " diva ed <br />SAY Jot (a any corporation, partnership cwp, 'flarthrica"ation Of &to Motion thanto, or paid, and will not pay, <br />thercrif to OffiXIATOO A Collsivo or shoor bid. IV orrodialov. bid depository, Or to any mandior or split <br />Note: '"w above Non,culluslom, Affidavit is part orla, propml, Signing fill$ NO Sol 01, 0 SI failure. <br />-9"�011ushrmAffiidavu. BIDDERS are cautioned that <br />portion thereof Shelf also moslione allpmawn Of this po th <br />a- Irr to orlinhad prowjum. <br />"0' <br />Signed 74FIS' 'r <br />State orcatzrom-In <br />County of <br />ilubscallbed Sold MID to (" offirtmed) before, on, on his 15- day of H�e,� , 2ota by <br />provad to Inc on like basis of satisfactory 0,71'k—INO to t� the appeared <br />before Inc. <br />--7---aT-A0L00- <br />6'i . At�� <br />V <br />f Wars Conly <br />Nanny Public Sm <br />25E-457 <br />