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uAppeA dix <br />ATTA01MT 34; " 'N-COLLUSit} ENN AFFWOIT <br />, CE'RTXRXCA:TXONS N <br />NON-COLLUS10 AFFID� <br />(Title 23 United States Code Section 112 and <br />Public Contract Come Section 7106) <br />To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />1n 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 />overhead communication,fit or cost element it the price, or of that of any other fthe BIDDER or any BIDDER, or to Fix any <br />anyoneprice <br />pro pri ,IIDDER, 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 ore 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 corpreadon,parMership, company association, organization, bid depository, or to any member or agent <br />thereof to effectuate a collusive or sham bid. <br />Note: The stove Nan -collusion Affidavit is part of the Proposal, Signing this Proposal on the signature, <br />portion thereof shall air monstitutc signtaturq of this Non -collusion Affidavit, BIDDERS are cautioned that <br />Signed <br />State of California <br />County of <br />Subscribed and sworn to (or affirmed) before me on this day of , 20 , by <br />proved to me on the basis of satisfactory evidence to be the persons} who appeared <br />beforemo. <br />f F <br />Notary Public Signature Notary Public Seal <br />City of Santa Ana RFP <br />Page A3-1 <br />