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APPENDIX <br />ATTACHMENT D -1: NON - COLLUSION AFFIDAVIT <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL ENGINEERING SERVICES <br />RFP NO.: 14 -037 <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 cast 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: The above Non - collusion Affidavit is part of the Proposal. Signing this Proposal on the signature <br />portion thereof shall also constitute signature of this Non - collusion Affidavit. BIDDERS are cautioned that <br />making a false cerdill tien ay subject the certifier to criminal prosecution. <br />Signed , < <br />State of California <br />County of t� <br />Subscrl a and sworn o (or affirmed) before me on this _a— day of , 20(1 by <br />proved to me on the basis of satisfactory evidence to be the person(s) who <br />appeared before me. <br />HILARY HYNEK GOSHERT <br />Commission # 2078078 <br />Notary Public California ZZ <br />dl-- Orange County <br />Nota ublic Si nature tJ Notary Public Seal My Ceram. Expires Au 16, 2018 <br />PROPOSALSTHATDO <br />City of Santa Ana RFP 14 -037 <br />Page 26 <br />25M -71 <br />