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CITY OF SANTA ANA <br /> ATTACHMENT D <br /> NON-COLLUSION AFFI DAVIT <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 ther f shall also constitute signature of this non-collusion affidavit. Proposers are cautioned that <br /> making a fats certification ma,st.jgct the certifier to criminal prosecution. <br /> Signed <br /> State of XAS ,County of Dallas <br /> Subscribed and sworn to(or affirmed)before me on this gam' day ofG(t� 20Lq ,by <br /> DeMse SYtarp ,proved to me on the basis of satisfactory evidence to be the person(s) <br /> who appeared before me. <br /> ��, / Luz Marla Rodriguez <br /> G MY Camititaton EMpIros• <br /> Not blic Signature / Notary Public Seal /R�►� ei3r21726 <br /> � �� Nolary ID 130687247 <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 RFP 24-060A Page 36 of 42 <br /> Tangram Interiors I City of Santa Ana 10 <br />