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CpfY OF SANTA ANA <br />PROJECT09- 6076:17'" STREETTRIANCLE <br />PROPOSAL AND CONTRACT AGREEMENT <br />NON-COLLUSION AFFIDAVIT <br />(fitla23 United States Code Section 112end <br />Public Contract Code Section 7106) <br />TotheCITYOFSA ITT AANADEPAR 'fMENTOFPUBLICWORRS <br />In xoordance with Title 23 United Sle[es Cade Section 112 and Public Contrac(Code 11061he BIDDER <br />decIares fat the bid is noI made in the interest of, or on beflal[ o� any undisclosed person, peMershig <br />company, assrociaGo4 organizatien, or corporation; that the bid is genuine and not collusive of sham; fat <br />(he BIDDER has not directly or ioNr¢ely induced or solicited any other BIDDER to put in a false or sham <br />hid, and has not directly or indirectly collided, conspired, connived or agreed with any BIDDER of anyone <br />else Ie putin asham hid,ortltatan}roce slarh rehain hombldding; ThallheBNDER has notinany manner, <br />directly or indirectly, sought by agreement, commanicatien, or conference with anyone m fis the bid pace <br />of IheBmDER crony BIDDER, orto Ba anyoverhead, profit, or cost element of lhebidprice, oro[thatof <br />any other BIDDER, or to secure any advantage against the public body awarding the <br />runtract of anyone <br />interested in the proposal contract, that all stateu�nts contained in the bid are Ime; and, funhar, That the <br />BIDDER has noh direclty or indirectly, submitted his or her bid price or any breakdown thereof, or !� <br />ronlents thereat, or diwlg¢d infonnahCn or data relative thereto, or paid, and will not pey, any fee to any <br />co�pomtbq paMership, company association, organization, bid depository, or [o any member or agent <br />Ihereo(lo effectuate a colosi�eor sham hid. <br />Note: The a6oue Non rollusicn Affidavit is pan of the Proposal. Signing this Proposal on the <br />signalurepotfionlhareofshallalso�' gsulotesigoawreoflltisNoncollosiooAffdavit BIDDERS <br />areoaotronedThalmakingaDlse catioumaysubject�hecetbfiertocnndnalproseculion. <br />Signed SHAMAN SHADROU <br />Stale of California <br />County of dos Aopeles <br />Subscnhed and swam ro (or affmned) before me on this � day of G�f. , 2WL by <br />s , proved ro me on the basis of salsfaerory evidence to be the peraon(si who <br />appeamAbeforeme <br />Notary Public Signalurc <br />PEICfl E, SCNfCHiEt <br />� Cammissieo X 1940192 <br />i.,�'o: � Noltry Putlllo�Cslllorolo ' <br />�'ij� los pog¢Iea Caunly <br />My Comm Eryiru Jan 1, 4015 <br />Notary Public Seal <br />BPllofl7 <br />