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APPENDIX EXHIS``IT p- 1: :NO.N- CQ'LLUSION AFFIDAVIT I CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR ON -CALL DEMOLITION SERVICES RFP NO.: 14-026 NON - COLLUSION AFFIbAVI7 (Title 23 United States Code Section 112 and Public Contract Code Section 71 06) To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS in accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made In the Interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, Note- The above Non - collusion Affidavit is part of the Proposal Signing this Proposal on the signature portion thereof shall also constitute sign fq�of this Non - collusion Affidavit BIDDERS are cautioned that making a f ficati m y s bI the gertifierto criminal prosecution Signed State of Ca ifo nia County of sort e and sworn to (or affirmed) before me on this day of 20 by j� r proved to me on the basis of satisfactory evidence to be the person who appeared before me qWK:198EALEYA'M4 MM, y20E9644 as ry Putilla Calttamta Crange counm, IrasJu 17 AA17 INotary Pu 'c Signature Notary Public Seal THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE.