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CITY OF SANTA ANA
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<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 corporation; that the proposal is genuine and not
<br />collusive or 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 to 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 public body awarding the contract of anyone interested in the
<br />proposed contract; that all statements contained in the proposal are true; and, further, that the proposer
<br />has not, directly or indirectly, submitted his or her proposal price or any breakdown thereof, or the
<br />contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any
<br />corporation, partnership, company association, organization, 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 ce�tion may subject the certifier to criminal prosecution.
<br />Signe
<br />State of , 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 the person(s)
<br />who appeared before me.
<br />See Attached
<br />Notarial Certificate
<br />Notary Public Signature Notary Public Seal
<br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL.
<br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE.
<br />City of Santa Ana RF'P 24-034 Page 31 of 34
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