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CITY OF SANTA ANA <br />PROJECT 13-2636: SANTA ANA ZOO NEW OCELOT EXHIBIT <br />PROPOSAL AND CONTRACT AGREEMENT <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 <br />BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, <br />partnership, company, association, organization, or corporation; that the bid is genuine and not <br />collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other <br />BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived <br />or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from <br />bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, <br />communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to <br />fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure <br />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, <br />directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, <br />or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation; <br />partnership, company association, organization, bid depository, or to any member or agent thereof to <br />effectuate a collusive or sham bid. <br />Note: The above Non -collusion Affic <br />signature portion thereof shall also <br />BIDDERS are cautioned Aat malyng <br />prosecution. a // // / <br />Signed <br />State of Califofnin <br />County of�Zl - <br />part of the Proposal. Signing this Proposal on the <br />nue signature of this Non -collusion Affidavit. <br />certification may subject the certifier to criminal <br />Subscribed and swom to (or affirmed) before me on this .43 day of_�, 20L, by <br />/ /44_o k- Le./ ^ 4 ✓ , proved to me on the basis of satisfactory evidence to be the person(,) <br />who appeared before me. <br />I �a W .cam< as <br />9NARk W. MASTERS <br />COMM. # 1928729 z <br />"' 431e NOTARY PUBLIC -CALIFORNIA <br />qj ORANG[:COUNTY <br />My comm. Expires April 11, 2816 <br />Notary Public Seal <br />BP -12 <br />