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CE 11, 1If IOA -I IUhd>
<br />ATTAC"IHIMENT 3-1
<br />Appendix
<br />ATTACIIMFENT 34: NON-COIJA SIGN AFF1 DAVIT
<br />CLIL'I'1I%ICATIONS
<br />NON-( OL.I1I,,5,(„CON APFIDAVn'
<br />(Title 23 United Sulks Cnete Sxtion 112 and
<br />Public Conrraci Coil, Sedion 71(16)
<br />Tu the CITY Of SANTA ANA DEPARTMENT OF PLiHUC WORKS
<br />In accoidaoce with Title 23 t!nitcd SrAlcs Code Sectintt 1 12 imd Public Contract, Code 710E the BIDDER
<br />declares that the hill is not nnadc in the interest of, or on Ill of, any undisclosed Larson, pa,inership,
<br />emnpany, »mociation, or.ouniriition, or corporation: t1tat the bid is geu,ire and not collusive or sham; that
<br />the BIDDER has not directly fir indirectly induced or solicited piny odnet- BIDDER to put in a false or shalll
<br />hid, and has not directly or indirectly colluded, conspired, connived or agreed with any 1111)DER or anyone
<br />else to lilt in a sluun bid, rn that anyone shall refrain Item bidding; 111A the BIDDER has not in any
<br />manner, directly or mdirec(ly, sought by agreement, collocation. or conference with ariyore to fix the
<br />bid price of die BIDDER or any RIDDLR, or to fix any overhead, Prntit, or cost clement of the bid price,
<br />or of that of any other RIDDER, or u) ..euire any advantage aS inst, die public body awarding the contraeL
<br />of anyone inicrestcd in the Proposed contract: that till statements contlomd in die bid are true, and, Ruihei,
<br />that the BIODI :R has not, directly or indirectly, suhntinetl his or her bid lViee or brr.+kdown [hereof, or
<br />the cowuita thereof, or divulged information fir deal relative thereto, or paid, and will not pay-, any fee to
<br />any cniprotuion, plutneiship, crnnpany association, organisation, bid deposi(ury, or to any member or agent
<br />therucof to effectuate a collusive or shall, bid.
<br />Note: 'I fie ahovc Non collusions AfhdivOt is fait of the Proposal. Signing this proposal m) the
<br />signanlrc portion thereof ~hall idso consnnu,.ign,norc of this Non -collusion Affidavit. 131UDFRS
<br />are cautioned thatin'Aing it false celmfica n miry subject doe cerrticr to criminal proecx;uuon.
<br />Signed
<br />.Stile Of C'alilnmia .�OtaryµbticoroiM1ef Ill Ift comprgfing>hMx�uoI"
<br />YnI" [Mitl toy of[Mcale I unto Of L,kdnot
<br />(_UUIILy fit _� tltcunInt Myth �li C.1 ftli lif li fltbChftl, o lml
<br />Ibe [nxMuNat, �iauncy, �r wlitll(1' Of M61 f10l�l
<br />SuhncnhcA and owoln in (or attirntedj befurc file on this day of 2p21 by
<br />t• r L-ov U x- v=-- rovnl to oo. on the baAiA fit SaiisLactor evtdcncc t
<br />f P Y o be the p •ison(s wllo zppemed
<br />before role_
<br />7 ( r x
<br />N rary P ill, Signunlrc
<br />'W, RkSHAULTTr LA/
<br />-CI
<br />�Yt L p. .Ana Ir LSl
<br />Notary Public Seal
<br />City of Santa Ana kFP 21}130
<br />Pagu A3-1
<br />City Council 23 — 46 4/20/2021
<br />27 i -:/ /,'..rt A, 10-11j
<br />I/' }Ili¢ IPIAN _LAh'AFKH lriA.lgN
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