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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON-CALL RIGHT OF WAY SPECIALTY SERVICES <br />RFP NO.: 13-075 <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, company, <br />association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER <br />has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has <br />not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a <br />sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or <br />indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or <br />any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to <br />secure 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, directly or <br />indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged <br />information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company <br />association, organization, bid 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 signature portion <br />thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that making a <br />false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of�„�,,,;, <br />ub cribed ands o 11to (or affirmed) before me on this 0 ,, day of UCPMiiXV' 20�, by <br />proved to me on the basis of satisfactory evidence to be the person(s) who <br />appeared before me. <br />AMANDA JEAN YHOMP$Ok <br />Commission M 2023320 <br />�Sr Notary Public • California z� <br />e <br />Orange County <br />4"Otary Publ Signatura� Notary Public Seal M Comm. txpiras Ma 4, 2017 <br />