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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR ACTUARIAL VALUATION SERVICES <br />FOR OTHER POSTEMPLOYMENT BENEFITS (OPEB) <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, further, <br />that the proposer has not, directly or indirectly, submitted his or her proposal price or any breakdown <br />thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not <br />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 proposal. <br />Note: The above noncollusion affidavit is part of the proposal. Signing this proposal on the signature <br />portion thereof shall also constitute signature of this noncollusion affidavit. Proposers are cautioned <br />that making a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California, County of Sa C4,-A w eyc- <br />Subscribed and s.w�7orn to (or affirmed) before me on this l6 day of v� l _, 201q—, by <br />' -C rG" C (7ruLJ's proved to me on the basis of satisfactory evidence to be the person(s) <br />who appeared before me. <br />No ary P ablic Signature <br />PBiX 1.0 - <br />Commission # 2008040 <br />.,M Notary Public • California .y <br />- sacrameeto County <br />M 'Comm. Ex Tres Jan,5, 2017 <br />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 />17 <br />