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CITY OF SANTA ANA. <br />PROPOSAL <br />PROJECT NO,: 21-7537 <br />MAIN LIBRARY CEILING IMPROVEMENTS <br />NON-C LLUSI N 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 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 <br />and not collusive or sham; that 03e BIDDER has not directly or indirectly induced or solicited <br />any 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, <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 are <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 Non -collusion Affidavit is part of the Proposal, BIDDERS are cautioned that <br />making a false certification mubject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of <br />sworn to (or affirmed) before me on this day of (Vw , 26j� by <br />proved to me on the basis of satisfactory evidence to be the <br />p eared before me <br />Notary Public Seal <br />ra <br />A Ifioupriti publlc.er olheagPocer cogtpf sting this certificate verifies only the <br />Identify of the Individual who sif{nedtfte document to which this Certificate <br />Is attached, and not the truthfulness, accuracy, or validity of that documem <br />state of califoc is <br />county of,;, '� ✓l r) .e <br />Subscribeifs4 satom to or affirmedl before me on tin 9'l day <br />of�0. <br />�25 ...20 by (/\ <br />#: <br />the basis <br />•"of satisfactory eviller a to. ct - rson(sl w ppeered before me. <br />s timulkere (Seal) <br />—Iar <br />EVAN BISSErT <br />Notary Public - California <br />Orange County <br />Commission d 229000 <br />My Comm. Expires May 26, 2023 <br />P-11 ofP-17 <br />