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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 06-3510 <br />SAN LORENZO SEWAGE LIFT STATION <br />NON -COLLUSION AFFIDAYIT <br />(Title 23 United States Code Section 1 ] 2 and Public Contract Code Section 7106) <br />In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the <br />BIDDER declares that the bid is not made in the interest of, or on behalf of any undisclosed <br />person, partnership, company, association, organization, or corporation; that the bid is genuine and <br />not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other <br />BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, <br />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 <br />agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any <br />other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any <br />other BIDDER, or to secure any advantage against the public body awarding the contract of anyone <br />interested in the proposed contract; that all statements contained in the bid are true; and, further, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown <br />thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will <br />not pay, any fee to any corporation, partnership, company association, organization, bid <br />depository, or to any member or agent thereof to effectuate a collusive or sham bid. <br />Note: The above Dlon-collusion Affidavit is part ofthe Proposal. BIDDERS are cautioned <br />Aqt tnakiIM a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of Draripie <br />Subscribed and sworn to (or affirmed) before me on this q_ day of JOY , 2011, by <br />G0AA ib Vi _.. proved tome on the basis of satisfactory evidence to be the person(s) <br />who appeared before me <br />,lly] — A - A - � my�- <br />Notary c PubliSI nattn Notary Public Seal <br />il: <br />�`°"�d, "LSIEMICNIKOGOME5' <br />iv 6 017MW. # 2248178 <br />� ► R NOTNtYPUgt�d;A1IFOpN�p <br />OC ' OJLaNGE GOUMTY <br />rca tt,JXP.�uMeIS,202 <br />P-12 ofP-17 <br />