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NON -COLLUSION AFFIDAVIT <br />(Title 223 Umited States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA Ai`IA DEPARTMENT OF PUBLIC WORKS <br />In accordance with Title 23 Ignited States Code Section 112 and Public Contract Code 7106 the BIDDER <br />declares that the bid is not made in the interest of or on behalf of, any undisclosed person, partnership, <br />company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that <br />the BIDDER has not directly or indirectly induced or solicited any ether BIDDER to put in a false or sham <br />bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone <br />else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any <br />manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the <br />bid price of the BIDDER or any 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 award n0 the contract <br />of anyone interested in the proposed contract; that all statements contained in the bid are true, and, feather, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or <br />the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to <br />any corporation, partnership, company association, organization, bid depository, or to any member or agent <br />thereof to effectuate a collusive or sham bid. <br />Note: The tf �ove Non-cAlu ion Affidavit is part of the Proposal. Signing this Proposal on the <br />signature ptiiioki thereof}sl i lalso constitute signature of this Ton -collusion Affidavit. BIDDER <br />are cautio/nAtl t ni aUig�=false certification may subject the certifier to criminal prosecution. <br />Signed - Darren J. Adrian, P.E., Sr. VP <br />State of California <br />County of <br />Subscribed and sworn to (or affirmed) before me on this _ day of Ada <br />20j2A by <br />i14rUproved to me on the basis of satisfactory° evidence to he the perswh on( o appeared <br />efore me. <br />No 4 ry ubignatureNotary Public Seal <br />LISAM. SMITH <br />Notary Public - California <br />- Orange County <br />Commission 3 2347950 <br />MY C—m, Exirires Feb 19, Z[i25 <br />City of . RFP 22-002 <br />Page A3-1 <br />