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NURTA <br />Utility Response Training Associates, LLC <br />Attachment D: Non -Collusion Affidavit <br />CITY OF SANTA ANA <br />ATTACHMENT D—� <br />NON -COLLUSION AFFIDAVIT <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 certification may subject the certifier to criminal prosecution. <br />State of.(:X:Lfa(Jim County of V <br />S�bsGribe and( sw,om to(oraffirmed) before me on this �� day of-ftl�-� , 20? by <br />b i{ U proved to me on the basis of satisfactory evidence to be the person(sy' <br />who appeared before me. <br />Notary Public Signature <br /><sES <br />; 3 <br />i <br />HA ANI <br />M395758 <br />a <br />,• <br />C.ONN M23�JLI7G8 <br />GWO, <br />8 <br />R <br />i <br />L[� Y[i VEa. P la ( Nl A <br />�NTUftA COt1NlV <br />t <br />If <br />I <br />Notary Public Seal <br />� THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. I <br />� PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. I <br />RFP 23A884 City of Santa Ana Page 41 of 47 <br />URTALLC- P.O. Box 101, Oak View, CA 93022 <br />