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<br /> • CITY OF SANTA ANA <br /> PROJECT NO. 09-1751-C <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 manner, <br /> directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price <br /> of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of <br /> any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone <br /> interested in the proposed contract; that all statements contained in the bid are true; and, further, that the <br /> BIDDER has not, directly or indirectly, submitted his or her bid 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 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 <br /> are cautioned that ma ~ g a false certification may subject the certifier to criminal prosecution. <br /> Signed~~~ <br /> o loert 3rcu~l~ V ~ ~ r~2yi d~l~ll- <br /> State of California <br /> County of ~y <br /> Subscribed and sworn to (or affirmed) before me on this day of ~rni 1 2010, by <br /> '~.1~j/-}- ~@~~~ ,proved to me on the basis of satisfactory evidence to be the person who <br /> appeared before me. <br /> DEH81E A. MATSEN <br /> Commission # 1775685 <br /> ~ ~ ~ Notary Public -California z <br /> M`,' Riverside County = <br /> My Ccmr~~. Exokes iJcv 22, 20i 1 <br /> Notary Pu tic Signature Notary Public Seal <br /> TO BE INCLUDED iN BID PACKAGE <br /> BPllofl3 <br /> <br />