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CITY OF SANTA ANA <br />RFP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />NON -COLLUSION 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 and <br />not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other <br />BIDDER, to put in a false or sham bid, and has not directly or indirectly colluded; conspired, <br />connived, or agreed with any BIDDER or anyone else to put in a sharn bid, or that anyone shall <br />refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by <br />agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any <br />other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any <br />other BIDDER, or to secure any advantage against the public body awarding the contract of anyone <br />interested in the proposed contract; that all statements contained in the bid are true; and, further, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown <br />thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will <br />not pay, any fee to any corporation, partnership, company association, organization, bid <br />depository, or to any member or agent thereof to effectuate a collusive or sham hid. <br />Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are cautioned <br />that making a false cegti ation may subject the certifier to criminal prosecution. <br />Sighed � /�✓{. •,/( A.rmtary public or other officer oomplel n _t_!i _ <br />cerfi. ratue Vert rat only aw Sdennty o they <br />individual who signed the do Fun, to which (his <br />State Of California w, tificate is attaclied, and not Ute n uthtltlnesa, <br />County of _ acearacy, or validity or thatdocamaot. <br />Subscribed and sworn to (or affirmed) before me on this Q day of &0 203 by <br />�lblte �._Ai&44r proved to me on the basis of satisfactor evidence to be the person(ej <br />who appeared before me COLEiI E L. GOOOON <br />� ••-It�verside <br />Notary Public Signature Notary Public Seal <br />Page 7 of 10 <br />