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CITY of SANTA ANA <br />ATTAI`-Im E NT D <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Conlred Code Section 7106) <br />To the CITY OF SANTA ANA <br />In 30cordance with Title 23 Uniled 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, arty un6sclosed person, <br />partnership, cornpany, association, organization, or corporation; that the proposal is genuine and not <br />oolluSive or scram, that the proposer has not directly or indirectly induced or solicited any othef proposer <br />10 put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived or <br />agreed with any prcpvsef 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 inderectly, soughl by agreement. <br />Com m un icallion, or conference with anyone to fix the proposal price of the proposer or any proposer, a <br />to fix any overhead, prafd, 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 anyorte interested in the <br />proposed contract, that all statements cautaned 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-callusion affidavit. proposers are cautioned that <br />making a false certit«catton may subject the certifier to criminal prosecution, <br />Signed <br />State of V fJ County of t f 4 LA <br />, f <br />bscr ed nd swam to (or affirmed) before me on this day ofFA410tf , 20� `t , by <br />0 proved to me cn 1he basis of satisfactory evidence to Vthe person(s) <br />who appeared before me. <br />Notary Public Seal <br />THIS FOR M MUST BE COMPLf TED AND INGLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WALL BE CONSIDERED N0NRE SPONSIVE <br />City al Santa Ana RFP 244X2 Page 31 of 34 <br />