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CITY OF <br />REQUEST •^ PROPOSALS <br />FOR <br />FOR PACIFIC ELECTRIC PARK <br />RFP • i <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: Th - collusion Affidavit is part of the Proposal. Signing this Proposal on the signature <br />porno erect shall als constitute signature of this Norncollusion Affidavit. BIDDERS are cautioned that <br />mak g Ise �tifiVi p may -ssti b,[ect the certifier to criminal prosecution. <br />Signed <br />State of C <br />County of <br />bscribed and sworn to (or affirmed) before <br />ri" Ak ag4-` li o) proved to me on the basis <br />appeared before me. 4 <br />tary Public Sign ture� <br />Notary Public Seal csmm. tx rtes oet 1B 2 i7 <br />THIS FORM MUST BE COMPLETED AND <br />PROPOSALS THAT DO NOT CONTAIN THIS FORK <br />City of Santa Ana RFP 14 -036 <br />Page 20 <br />SAN JUAN CAPISTRANO • SACRAMENTO 16 <br />www.RJMdesigngroup.com , [9491493 -2600 <br />