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C�1 Y 1►•L�a �Y_ \III II_�i�/_� <br />PROJECT NO. 116734: CHESTNUT AVE. FROM STANDARD AVE. TO ELK LN. <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 <br />BIDDER declazes that the bid is not made in the interest of, or on behalf of, any undisclosed person, <br />partnership, company; association, organization, or corporation; that the bid is genuine and not <br />collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other <br />BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived <br />or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from <br />bidding; that the BIDDER has not in any manner, directly or indirectly, .sought by agreement, <br />communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to <br />fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure <br />any advantage against the public body awazding the contract of anyone interested in the proposed <br />contract; that all statements contained in the bid aze true; and, further, that the BIDDER has not, <br />directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, <br />or divulged information or data relative thereto, or paid, and will not pay, any fee. to any corporation, <br />partnership, company association, organization, bid depository, or to any member or agent thereof to <br />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. <br />BIDDERS aze cautioned that making a false certification may subject the certifier to c*�rninal <br />prosecution: <br />Signed <br />State of California <br />County of <br />Subscribed and sworn to (or affirmed) before me on this day of 20� by <br />,proved to me on the basis of satisfactory evidence to be the persons) <br />who appeazed before me. <br />Notary Public Signature Notary Public Seal <br />BP 11 of 13 <br />