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CITY OF SANTA ANA <br />PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST <br />PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'i ST 8c KING ST <br />PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV <br />PROPOSAL AND CONTRACT AGREEMENT <br />NON-COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 1 12 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 effectuate a collusive or sham bid. <br />Note: The above Non-collusion Affidavit is part of the Pro sal. Signing this Proposal on the <br />signature portion thereof shall also constitute signature of thi on-collusion Affidavit. BIDDERS <br />are cautioned that making ?fal?-certification mays subject t e certifier to criminal prosecution. <br />Signed <br />State of California V <br />County of <br />Subscribed and sworn to <br />appeared before me. <br />Notary Public Signature <br />(or affirmed) before me on this ?Jday of <br />proved to me on the basis of satisfactory evidence to <br />Notary Public Seal <br />IJ L.'tJ <br />?1- by <br />be the person(s) who <br />TO BE INCLUDED IN BID PACKAGE <br />BP 15 of 32