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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 c3,tfiqation may subject the certifier to criminal prosecution.
<br /> Signe
<br /> .01
<br /> State of��, County of s5W ]:?l�i&Z)
<br /> Subscribed and sworn to (or affirmed) before me on this day of 120 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 o0itytDownclI RFP 24-0340 —40 7/1 6QWA of 34
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