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• CITY OF SANTA ANA RESIDENTIAL STREET REPAIR RECONSTRUCTION -PHASE 12 PROJECT NO. 106718 PROPOSAL AND CONTRACT AGREEMENT NON-COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone • interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non-collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non-collusion Affidavit. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed T ~ - © , ~j rCLd ~°(~~ ~(IC~2 State of California County of ~1Vt_1~hide ` Subscribed and sworn to (or affirmed) before me on this ~~VL day of Qe~Pm 20(x, by -~- ~rQ d l~°~, proved to me on the basis of satisfactory evidence to be the person() who appeared before me. DEBBIE !Y. Mr~TSEN :~" ~- '~- Ccrnmisslon # 1775bII5 z : ~m 6. ~~' Notary Public - California Z Z ~'~ ~ Rlvsrsid~ Counfy ~~ Nh/ CanYn. ~~iras h;ov 2 c, 2~1 i t Notary Public Signature Notary Public Seal BP 12 of 14 TO BE INCLUDED IN BID PACKAGE