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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 sham 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 bid. <br />Note: The above Non -collision Affidavit is part of the Proposal. BIDDERS are cautioned <br />that making a false certi I ation may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of _ <br />A notary public or other officer <br />ilduAt IWo.Iif verilICS only the rctcntity of the <br />i?"� ivldual vaho silyh ned tire document to which this <br />ceitiiieate is attached, and not the truthfulness, <br />a(;curacy, or validity of that document. <br />Subscribed and swot to (or affirmed) before me on this � day of F,4 , 20:21 by <br />.P!•t?rZ�3 f), /�nCa/r,,±r�_proved to me on the basis of satisfactory evidence to be the person(4 <br />who appeared before me COLETTE L. GORDON <br />o COMM. #2296433 r <br />Notary Public - California <br />= Riverside County <br />Comm. E ires Aug. 4, 2023J <br />Notary Public Signature Notary Public Seal <br />Page 7 of 10 <br />