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<br />City of Santa Ana
<br />Certifications
<br />Non•Colluslon Affidavit
<br />. A l i i'di777
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<br />i' r rimer14: NON- ar,u..ri..�.{rF•�.i'!rl frj •.�.i' ..•.,l J. "'•,
<br />/:i+; ir•/t. /.�A/� �1AYAJrNT,�//�r).1p, 81.0dV r t ��' �'•r '�i. �r
<br />UMMI U oN AMWAVIT
<br />M1102@ UAIW Stalo Code Seedon 112 and
<br />p'ohlio Comraal Code Sootlon 7106)
<br />TO tpo ON'Y0P SANTA ANADEPARTmgNT pFxmLIC WORKS
<br />In aceWdanoe with 1Ytlo 23 United Status Coda Soadon 112 and Pahlia'Cotiunat Code 7106 the SIMMER doola os
<br />that die bid Is not made, it; 't ie lnterest.of, or on baholW any undisclosedgsramG pn tnonhtp, oomppny, assaoladdn,
<br />organization, or aorp01*104l that the bid is gunolue and list collusive ornhmnl Oral the RIMIER has not dheotly or
<br />Indireoliy Induced or xoRohed any.minpr SIDMEIt is put In'A 141115 m• ahmn bid, And hos not dir®otlycr Indlocelty
<br />oplluded, csnajobed, connived or agrood with any SIDDL'R ar win: also to put In a ahmn bld, or that Anymto shalt
<br />rofiarin from bidding,, dint the'RIIDP.It bau not Iia tiny mmmer, directly or lndtraody, sought by aproomenl,
<br />coinmunieadou, or oonfdronoo Mill AIWcnra is fix Ilia bid price of due IdIDIER Or Puy MI)DPR; •at' to * any
<br />ov l4oftd,profit, or owl ulowentofthe OldPick orofthstofany blherbS7IRIt,ortosacuan'say advanlogoefedust
<br />Ilio publio• body awarding the contrast of anyone hnoreated Ib lho ptoposed ehAtmet; that 101 st4ismams aantnhmd in
<br />Ilia bid aro trust and, Abilhor, that the HIDpEIt has not, directly ar Indhoolty, submihad 1118 aa' her bid pripa or any
<br />brealedown tlwrcolr or dw oontentj thane , or dtvglgad intbrmnuion or 411%mintiva tlroreio, or pald, aadwill not pey,
<br />ally fee to Arty corporation, perbrerAlp, Company 4ssanladon, orgonlcniton, bid dotowltory, ar to any mambor or agent
<br />,dlarapf to ehbetume a collusive or obam bid.
<br />NOW Tho Above Non•calluslsn Affidavit is pail of the proposal, tisgrnng tills proposal on 'Ilia signattuo
<br />portion thdroofahntl also cousllhne slgtmntro of this Non•collustou Affidavit. BIDDERS aro cotdioned that
<br />moMnS 111ficationmay sugOgl.the cardGerwcriminal pttreapuilon,
<br />Signad
<br />State ofColifmnln p , �•' (� t
<br />County ofQ.F? Cx �Q1 D1 1�fi4'Ccu.l ll x4' `QJ \�r� l c st t.�r
<br />Subscribed and swot to (ol• W "Pani) behrto mo on this day of , 20,, by
<br />� llra ad tome on the basis of andsloolory pvidenou to be Iiia parsons) who appanwd
<br />before mo..
<br />NN aiy Pub Ic8iguatur'e .Nouny Pub eel
<br />H
<br />011y Oftlante Ana RFP
<br />Page AM
<br />T r�. Comprehensive. Innovative. Trusted,
<br />k A,. Proposal for On -Cali Enginmering,
<br />RFP No. 17.033
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