Laserfiche WebLink
05/92/2618 14:15 17607279332 PCWERLUX CCRPCP,ATSCH PAGE 01/01 <br />EXII G <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR LED POST TOP RETROPIT STREETLIGHTS <br />NONCOLLUSION AFFIDAVIT <br />NON- CQLLUSION AFFIDAVIT <br />(Title 23 United States Code Saotlon 112 and <br />Public Contract Code Section 7166) <br />Ta the CITY,OF BANTA ANA <br />In accordance with Title 23 United Sates Code Section 112 and Public Contract Coda 7166 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 oorporatlon; that the proposal Is genuine and not collusive or sham; that <br />the proposer has not directly or Indirectly Induced or solicited any other proposerto put In a false or sham <br />proposal, and has not directly or indirectly coliWded, 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 clamant 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 era hua; <br />and, further, that the proposer has not, directly or Indlrectly, submitted his or her proposal price or any <br />breakdown thereof, or the contents thereof, or divulged Information or data rolativo 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 s0poluaia a collusive or sham proposal, <br />Note: The above noncollusion affidavit is pert of the proposal. Signing this proposal on the signature portion <br />thereof shall also constitute signature of this noncollusion affidavit. Proposers ere cautioned that making a <br />faloe oonihcadon may subject the conifiar to criminal prosecution. <br />State of California, County of:A ! t <br />5 bsuribed a9d sworn to (or affirmed) before me on this, `i ✓• day — M�, m 20,�i , by <br />04 h �f, 4 �1 • , proved to me an the basis of sadsfaotary eviden to be the parsons) who <br />appeared before me, <br />\AV-14 � L <br />Notary Public Si ature <br />X0 @ WU <br />Cernmisslon # 1985329 <br />Notary PUNIC • California '•� <br />I: C6 AnddlOd County SS <br />Notary Public Seal <br />THIS FORM LIST HE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROP08AL8 <br />TOO NOT CONTAIN THIS FORM WILL Ur CONSIDERED NONRESPONSIVE. <br />RFP FOR LED POST TOP RETROPIT STREETLIGHTS Page 125 <br />25D -39 <br />