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CITY OF SANTA ANA <br />PROJECT NO. 10 -6600: SANTA CLARA AVENUE SEWER AND WATER MAIN <br />I1VII'ROVEMENTS <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 awarding 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 <br />signature porti� <br />Signed <br />State of California <br />County of (L...�- c`.e -� � <br />on Affidavit is part of the Proposal. Signing this Proposal on the <br />till also .constitute signature of this Non - collusion Affidavit. <br />malting a false certification may subject the certifier to cri_mi„al <br />Subscribed and sworn to (or a�"irmed) before me on this �o day of -Sn 20//, by <br />-_l • � - `—�e�s ca -� ,proved to me on the basis of satisfactory evidence to be the persons) <br />who appeazed before me. <br />LEON NORIEGA LOPEZ <br />COMM. #190750 <br />NOTARY ►lIBl1C - CALIFORNY► <br />RIVERSIDE COUNTY <br />My Coma. Exptr�s Oct. 9, Z01� <br />N gnature Notary Public Seal <br />BP 12 OF 14 <br />