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0 CITY OF SANTA ANA 0 <br />PROJECT NO. 099108 AND 089097: PLAZA OF THE FOUNTAINS <br />FOUNTAINS NO. 1 AND NO. 3 RENOVATION <br />PROPOSAL AND CONTRACT AGREEMENT <br />NON - COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER <br />declares that the bid is not made in the interest of,. or on behalf of, any undisclosed person, partnership, <br />company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that <br />the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham <br />bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone <br />else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any <br />manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the <br />bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or <br />of that of any other Bidder, or to secure any advantage against the public body awarding the contract of <br />anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or <br />the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to <br />any corporation, partnership, company association, organization, bid depository, or to any member or agent <br />thereof to effectuate a collusive or sham bid. <br />Note: The above Non - collusion Affidavit is part of the Proposal. Signing this Proposal on the <br />signature portion thereof shall also constitute signature of this Non - collusion Affidavit. Bidders are <br />cautioned that making a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of ',A�t pje � 0 <br />Subscribed and sworn to (or affirmed) before me on this R,� day of Jh4j_�J 2010 by <br />►n,A t_co5 c hk =�, to , proved to me on the basis of satisfactory evidence to be the person�4 who <br />appeared before me. <br />G.I QWNTERO <br />Com�EONO 103!81 <br />N0TARy •CX FWWA <br />SAN QUIP A <br />m, CONN 15.2012 <br />N taiy Public Signature Notary Public Seal <br />TO BE INCLUDED IN BID PACKAGE <br />BP 10 of 12 <br />