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EXHIBIT G <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR ON-CALL SEWER AND WATER SYSTEM REPAIR SERVICES <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 proposer <br />declares that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, <br />company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that <br />the proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham <br />proposal, and has not directly or indirectly colluded, conspired, connived or agreed with any proposer or <br />anyone else to put in a sham proposal, or that anyone shall refrain from bidding; that the proposer has not in <br />any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the <br />proposal price of the proposer or any proposer, or to fix any overhead, profit, or cost element of the proposal <br />price, or of that of any other proposer, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; <br />and, further, that the proposer has not, directly or indirectly, submitted his or her proposal price or any <br />breakdown 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 any <br />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 portion <br />thereof shall also constitute signature of this noncollusion affidavit. Proposers are cautioned that making a <br />false certification may subject the certifier to criminal prosecution. <br />State of California, County <br />Subscribed and sworn to (or affirmed) before me on this day of , 20_, by <br />, proved to me on the basis of satisfactory evidence to be the person(s) who <br />appeared before me. <br />Notary Public Signature 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 />RFP #14-044 — On -Call Emergency Sewer and Water System Repair Services <br />Page 24 <br />