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APPENDIX <br />EXHIBIT C -1: NON - COLLUSION AFFIDAVIT <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />PAVEMENT MANAGEMENT PROGRAM <br />RFP NO.: 13 -078 <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 declares <br />that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, <br />association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has <br />not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or <br />indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that <br />anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by <br />agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix <br />any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage <br />against the public body awarding the contract of anyone interested in the proposed contract; that all statements <br />contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid <br />price or any 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 depository, or to <br />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 signature <br />portion thereof shall also constitute signature of this Non - collusion Affidavit. BIDDERS are cautioned that <br />making a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of Gflk.� 0 r t Ca <br />Supscribed and sworn to (or affirmed) <br />{�� -F�r �u CKna w> proved to me <br />appeared before me. <br />ci�PF�12- t <br />Notary Public Signature <br />before me on this �119 day <br />on the basis of satisfactory evidence <br />BEATRIZ HANGIS <br />OWNCommission # 1872831 <br />Notary Public - California z ZSan Diego County '- <br />My Comm. Expires Jan 5, 2114 <br />Notary Public Seal <br />V <br />of Def-e^^ , 2013 by <br />to be the person(s) who <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />-- - - - - -- - - - -- ---- - - - - -- -- --------------- - - - - -- <br />City of Santa Ana RFP 13 -078 <br />Page 20 <br />