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CITY OF SANTA ANA <br />RFQ No. 22-005 State Legislative Advocacy Services Page 26 of 29 <br /> <br /> <br /> <br /> (Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br /> <br /> <br />To the CITY OF SANTA ANA <br /> <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the <br />Respondent declares that the statement of qualificationsis not made in the interest of, or on behalf of, <br />any undisclosed person, partnership, company, association, organization, or corporation; that the <br />statement of qualificationsis genuine and not collusive or sham; that the Respondent has not directly or <br />indirectly induced or solicited any other Respondent to put in a false or sham statement of qualification, <br />and has not directly or indirectly colluded, conspired, connived or agreed with any Respondent or anyone <br />else to put in a sham statement of qualification, or that anyone shall refrain from bidding; that the <br />Respondent has not in any manner, directly or indirectly, sought by agreement, communication, or <br />conference with anyone to fix the statement of qualificationsprice of the Respondent or any Respondent, <br />or to fix any overhead, profit, or cost element of the statement of qualificationsprice, or of that of any other <br />Respondent, 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 statement of qualificationsare <br />true; and, further, that the Respondent has not, directly or indirectly, submitted his or her statement of <br />qualificationsprice or any breakdown thereof, or the contents thereof, or divulged information or data <br />relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, <br />organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham <br />statement of qualification. <br /> <br />Note: The above noncollusion affidavit is part of the statement of qualification. Signing this statement of <br />qualificationson the signature portion thereof shall also constitute signature of this noncollusion affidavit. <br />Respondents are cautioned that making a false certification may subject the certifier to criminal <br />prosecution. <br /> <br /> <br />Signed____________________________________________________________________________ <br /> <br />State of California, County of __________________________________________________________ <br /> <br />Subscribed and sworn to (or affirmed) before me on this________ day of_____________, 20____, by <br />________________________, proved to me on the basis of satisfactory evidence to be the person(s) <br />who appeared before me. <br /> <br /> <br />________________________ <br />Notary Public Signature Notary Public Seal <br /> <br /> <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE STATEMENT OF QUALIFICATION. <br />STATEMENT OF QUALIFICATIONS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED <br />NONRESPONSIVE. <br /> <br />ATTACHMENT C <br /> <br />NON-COLLUSION AFFIDAVIT