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City of Santa Ana <br />ATTACHMENT D: <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br />In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 <br />the 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 <br />and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any <br />other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, <br />conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that <br />anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, <br />sought by agreement, communication, or conference with anyone to fix the bid price of the <br />BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or <br />of that of any other BIDDER, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained in the bid <br />are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid <br />price or any breakdown thereof, or the contents thereof, or divulged information or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, <br />organization, bid depository, or to any member or agent thereof to effectuate a collusive or <br />sham bid. <br />Note: The above Non -Collusion Affidavit is part of the Proposal. BIDDERS are <br />cautioned that making a false certification may subject the certifier to criminal <br />prosecution. <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 <br />person(s) who appeared before me <br />Notary Public Signature <br />Notary Public Seal <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City of Santa Ana <br />Ambulance & Paramedic and Collection Services <br />Request for Proposals: # 19-083 <br />September 13, 2019 <br />25B-66 <br />Page 143 <br />