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CITY ORSANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6453 <br />RiVERVIEW N131GIiBORWOOD WATER MAIN IMPROVEMENTS <br />NON-Ct71 117SI0N APPIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br />in conf'unnuncc with Titic 23 United States Code Section 112 and Public Contract Code 7106 the <br />BIDDER declares that the bid is not trade In the interest of, or on behalf of, any undisclosed <br />person, partnership, connpany, 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 <br />uny other BIDDER to out 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 />an) one Shull refrain from bldoling; that the BIDDERhas 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 outer BIDDER, or to fix any overhead, profit, or cost element of the bid price, <br />or 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 ate <br />true, and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price <br />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 sham <br />bid. <br />Note: The above Dion -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 Msika /y*%z TZAi" I It C2 <br />State of California <br />Countyof V tvcrs`•Id2 <br />Subscribed and sworn to (or affirmed) before me on this I day of &0v , 2( by <br />Apif Ain V2 ex 1y,-z , proved to me on the basis of satisfactory evidence to be the <br />persarr(s) who appeared before me <br />i, <br />Lary public Signature Notary Public Seal <br />_. oO JAMERCASTR6NZAM <br />COMW3110n No. 228t6NOTAWP M491ioN&A <br />Ft"AS CGown <br />MY CM1 EW04 MMCN. 17, 2¢23 <br />P-12 ofP-17 <br />