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0 <br />City of Santa Ana <br />ITEM 16: NON -COLLUSION CERTIFICATION <br />The undersigned hereby certifies on behalf of ("Proposer"), and <br />hereby declares under penalty of perjury under the laws of the State of California, that <br />this (TBD) EMS 9-1-1 Emergency Transportation Service RFP is genuine and not sham <br />or collusive, nor made in the interest of or on behalf of any person not herein named; <br />the Proposer has not directly or indirectly induced or solicited any other Proposer to put <br />in a sham proposal nor solicited any other person, firm or corporation to refrain from <br />submitting a proposal; the Proposer has not communicated, directly or indirectly, with <br />any other Proposer regarding the amount, price, and/or service rates proposed herein; <br />and Proposer has not in any manner sought by collusion to secure for <br />himself/herself/itself any advantage over any other Proposer. We declare the foregoing <br />is true and correct under penalty of perjury under the laws of the State of California. <br />Signed, this day of 2018 in <br />. California. <br />IF SOLE OWNER: <br />Signature of Owner <br />Date <br />Print Name <br />IF PARTNERSHIP (JPA or merger): <br />Signature of Partner (General Partner) <br />Date <br />Print Name <br />IF CORPORATION: <br />Signature of President <br />Date <br />Print Name <br />Signature of Secretary <br />Date <br />Print Name <br />City of Santa Ana Page 190 <br />Fire/EMS Emergency Ambulance Transportation and Related Services <br />Request for Proposals: # 18-059 <br />August 28, 2018 <br />