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CITY OF SANTA ANA <br />RFP NO.: 24-003 <br />CLOSED CIRCUIT TELEVISION (CCTV) INSPECTION OF SANITARY SEWERS <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 <br />7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any <br />undisclosed person, partnership, company, association, organization, or corporation; that <br />the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly <br />induced or solicited any other BIDDER to put in a false or sham bid, and has not directly <br />or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to <br />put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in <br />any manner, directly or indirectly, sought by agreement, communication, or conference <br />with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any <br />overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to <br />secure any advantage against the public body awarding the contract of anyone interested <br />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 <br />breakdown thereof, or the contents thereof, or divulged information or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partnership, company <br />association, organization, bid depository, or to any member or agent thereof to effectuate <br />a collusive or sham bid. <br />Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are <br />cautioned that making a false certification may subject the certifier to <br />criminal prosecution. <br />Signed <br />State of California <br />County of <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 <br />the person(s) who appeared before me <br />Notary Public Signature <br />Notary Public Seal <br />City of Santa Ana RFP 24-003 <br />Closed Circuit Television (CCTV) Inspection of Sanitary Sewers <br />Page 38 <br />