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Ar�c�crMNT X Nox cpAver <br />',1 ERTIIb)CAI OPtiS s 1 <br />NMLC R10N� <br />(Title 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 declares <br />that the bid is not made in the Interest of, or on behalf of, any undisclosed person, partnership, company, association, <br />organization, or corporation; that the bid is genuine 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 bidding; that the BIDDER has not in any manner, directly or Indirectly, sought by agreement, <br />communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any <br />overhead, profit, of 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 thereof, 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 any member or agent <br />thereof to efrectuate a collusive or sham bid. <br />Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature <br />portion thereof shall also constitute signature of this Noncollusion Affidavit, BIDDERS are cautioned that <br />making a false certification may subject the `„nitier to criminal prosecution. <br />Signed <br />State of California <br />County of Orange <br />Subscribed and swore to (or affirmed) before me on this 20th day of March, 201� by <br />Antonio J. Belello proved to me on the basis of satisfactory evidence to be the person(s) who appeared <br />before me. <br />ANTONIO JOSEPH <br />COMM # 2125941 <br />Z •Gp ORANGE COUNIY <br />4q NOTARY PUBLIC•CALIFORNIA� <br />y MY COMMISSION EXPIRES r <br />n SEP. 04, 2019 C <br />Notary Public Seal <br />�anan� <br />City of Santa Ana RFP <br />Page A3-1 <br />