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CITY OF SANTA ANA <br />PROPOSAL <br />Project No. 13-2638: Portola Park Improvements (Parking Lot, Basketball, Tennis Court <br />Renovation) <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 person, <br />partnership, company, association, organization, or corporation; that the bid is genuine and not <br />collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other <br />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, that <br />the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, <br />or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, <br />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 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 subject the certifier to <br />criminal nrosccu&n. <br />Signed <br />State of Cal <br />County of , <br />Subscribed and sworn to (or affirmed) before me on this 1�774 <br />-'day of J sr L , 20 J41y <br />pr to me on the basis of satisfactory evidence to be the person(s) <br />who appeared before me <br />Notary Public Signature Notary Public Seal <br />BP -12 <br />