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Es <br />CITY OF SANTA ANA <br />ATTACHMENT D~I <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the proposer <br />declares that the proposal is not made in the interest of, or on behalf of. any undisclosed person, <br />partnership. company, association. organization. or corporabort; that the proposal is genuine and not <br />collusive of sham, that the proposer has not directly or indirectly induced or solicited any other proposer <br />to put in a false or sham proposal, and has not directly or indirectly colluded. conspired connived or <br />agreed with any proposer or anyone else io put in a sham proposal. or that anyone shall refrain from <br />bidding that the proposer has not in any manner. directly or indirectly, sought by agreement, <br />communication or conference with anyone to fix the proposal price of the proposer or any proposer, or <br />to fix any overhead, profit or cost element of the proposal price, or of that of any other proposer. or to <br />secure any advantage against the pubic body awarding the contract of anyone interested in the <br />proposed contract, that A statements contained in the proposal are true: and further, that the proposer <br />has not, directly or indirectly, submitted his or her proposal pnce or any breakdown thereof, or the <br />contents thereof or divulged information or data relatrve thereto, or paid. and will not pay any fee to any <br />corporation. partnership. company association ogantzaton. bid depository. or to any member or agent <br />thereof to effectuate a collusive or sham proposal <br />Note The above non -collusion affidavit is part of the proposal Signing this proposal on the signature <br />portion thereof shall also constitute signature of this non -collusion affidavit Proposers are cautioned that <br />making a false certification may sub9act the certifier to criminal prosecutwn <br />State of 0, A , County of <br />a <br />�lbsrnhed ands�m to (or affirmed) before me on this day of 20� by <br />JO!L �,4uS = proved to me on the basis of satisfactory evidence to be the pefsooi;err <br />who appeared before me <br />No ry umc Signature <br />r`— yVOMIIE fIWS <br />M �� <br />w[! Ir Yr!•. iNr <br />Notary Public Sea] <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />PFP No 22-166 Davntonm Santa Ana Clean & Safe ream 41 <br />