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CITY OF SANTA ANA <br />PROJECT NO. 08 -1700, 12 -6421 AND 12 -6422 <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 <br />BIDDER declares 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 are 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 are cautioned that making a false certification may subject the certifier to criminal <br />prosecution. _ A /� <br />Signed <br />'�f'S�D�Y -F- �JI'QGi1t°L/l�%IG�t <br />State of California <br />County of Riy:°r5c,�� <br />Subscribed and sworn to (or affirmed) before me on this l �h day of �rnlct°,• 20�, by <br />�aboyt����°u ,proved to me on the basis of satisfactory evidence to be the persol� <br />who appeared beforeTme <br />Qz�Gc1%�.s ')'Y7crt�.oiv <br />Notary Public Signature <br />-•_ DEBBIE MATSEN <br />-� �•�; Commission # 1958174 <br />z = --^� � Notary Public - California z <br />� ��' � Riverside County > <br />M Comm. Expires Nov 22, 2015 <br />Notary Public Seal <br />BP 18 of 20 <br />TO BE INCLUDED IN BID PACKAGE <br />