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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT N0, 15-6836: RESIDENTIAL STREET REPAIR FY 14/15 <br />PROJECT 15-6452: WILSHIRE AVE. AND BORCHARD AVE. WATER MAIN IMPROVEMENTS <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <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 <br />person, partnership, company, association, organization, or corporation; that the bid is genuine <br />and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any <br />other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, <br />connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall <br />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 <br />BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other <br />BIDDER, or to secure any advantage against the public body awarding the contract of anyone <br />interested in the proposed contract; that all statements contained in the bid are true; and, further, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown <br />thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will <br />not pay, any fee to any corporation, partnership, company association, organization, bid <br />depository, or to any member or agent thereof to effectuate a collusive or sham bid. <br />Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on <br />the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. <br />BIDDERS are cautioned that making a false certification may subjectthe certifier to criminal <br />prosecution. <br />Signed <br />State of California <br />County ofi 08 ANul Pr <br />Subscribed and sworn to (or affirmed) before me on this „ day okwlt i i3 'Lt1520_� by <br />.-.CaK BROWN , proved to me on the basis of satisfactory evidence to be the <br />person(s) who appeared before me <br />Notary Public Si ature Notary Public Seal <br />�u�uPs <br />1t L9'JE7:7, U <br />r—j:7 <br />uLl�iG+h�4ttllA {� <br />BP -12 of 17pi¢a Oct.29.201E <br />23A-29 <br />