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EXHIBIT H <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR PROVIDING PARK JANITORIAL MAINTENANCE SERVICES <br />NONCOLLUSION AFFIDAVIT <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 <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the <br />proposer declares that the proposal is not made in the interest of, or on behalf of, any undisclosed <br />person, partnership, company, association, organization, or corporation; that the proposal is genuine <br />and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other <br />proposer to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, <br />connived or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall <br />refrain from bidding; that the proposer has not in any manner, directly or indirectly, sought by <br />agreement, communication, or conference with anyone to fix the proposal price of the proposer or any <br />proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other <br />proposer, 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 proposal are true; and, <br />further, that the proposer has not, directly or indirectly, submitted his or her proposal 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 proposal. <br />Note: The above non - collusion affidavit is part of the proposal. Signing this proposal on the signature <br />portion thereof shall also constitute signature of this non - collusion affidavit. Proposers are cautioned <br />that making a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California, County <br />Subscribed and sworn to (or affirmed) before me on this day of , 20_, by <br />, proved to me on the basis of satisfactory evidence to be the person(s) <br />who appeared before me. <br />Notary Public Signature Notary Public Seal <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />Park Janitorial Maintenance Services RFP 14 -002 <br />Page 39 <br />19C -41 <br />