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APPENDIX <br />ATTACHMENT 3 -I. NON - COLLUSION AT, FIDAVIT <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQ1JFST FOR PROPOSALS <br />FOR <br />ON -CAGE RIGHT OF WAY SPECIALTY SERVICES <br />RFP NO.: 15-044 <br />NON- CQLLUSION 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 that the bid <br />is not made in the interest of, or on behalf of any undisclosed person, Partnership, company, association, organization, or <br />corporation; that the bid is genuine and not collusive or sham, that the BIDDER has not directly or Indirectly induced or <br />solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or <br />agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has <br />pot in any manner, directly or indirectly, sought by agreement; communication, or conference with anyone to fix the bid price <br />of the BIDDER or any 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 interested in the proposed <br />contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, <br />submitted his or her bid price or any breakdown thereof, or the contents thereat, or divulged hiformadon or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, <br />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 the signature portion <br />thereof shell also constitute signature of this Non- collusion Affidavit, BIDDERS are cautioned that making a false <br />certification may siibjePt-fheortifier to criminal prosecution. <br />Signed <br />State of California <br />County of - <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 appeared before tie, <br />— -Selo a4aer ed <br />Notary Public Signature <br />Notary Public Seat <br />Ana F <br />rge 28 <br />25L -243 <br />