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CITY OF SANTA ANA <br />PROJECT 03 -6367_ SANTIAGO PARK VERNAL POOL <br />PROPOSAL AND CONTRACT AGREEMENT <br />NON - COLLUSION AFFIDAVI"I' <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 of %ctuate a collusive or sham bid. <br />Note: The above Non�ollusion A�da�+it is part of the Proposal. Signing this Proposal on the <br />signature portion thereof shall also constitute signature of this Non�ollusion Affidavit. BIDDERS <br />are cautioned th akin a false certification may subject the certifier to criminal prosecution. <br />-- <br />Signed � � � /� _.� -- <br />State ofCalifomia ��"��� /1 � YfI�CIC_ <br />County of �Sz_ <br />Subscribed and sworn to (or affirmed) before me on this � � day of �-P�t L . 20� by <br />�i4�'M�n1� R• P�7�CKEG(C proved to me on the basis of satisfactory evidence to be the person( who <br />appeared before me. <br />HEMANSHU P. BADANI <br />�, - � COMM...1906980 a' <br />() _ NOTARY PUBLIC- CALIFORNIA <br />n <br />m ORANGE COUNTY 41 <br />__.__. _ _���— d MY Term Erp. October 7, 2014 d <br />Notary Publi` gnature Notary Public Seal <br />TO BE INCLUDED IN BID PACKAGE <br />BP 10 of 12 <br />