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CITY OF SANTA ANA <br />PR 10 -6719: TRAFFIC SIGNAL EQUIPMENT REPLACEMENT – Phase I <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 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; <br />that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or <br />sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any bidder or <br />anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in <br />any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to <br />fix the bid price of the bidder or any bidder, or to fix any overhead, profit, or cost element of the bid <br />price, or of that of any other bidder, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained in the bid are true; <br />and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any <br />breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, <br />and will not pay, any fee to any corporation, partnership, company association, organization, bid <br />depository, or to any member or agent thereof to 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. <br />Signed <br />Subscribed and sworn to before me this <br />- -loth, — day of �LAe, ---- , 20 1, <br />Signed kl_I.F F" NYe JPZA.A,1� <br />Notary Public <br />Notary Seal: <br />LESLIE CLEVELAND <br />COMMIsSion # 1969117 <br />: ~ ' Notary Public - California <br />Orange County <br />M Camm, Explres j+lar 8, 2016 <br />BP 10 of 12 <br />