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APPENDIX <br />FA'FTACYY3MENT 3-1: NONN -COLLUSION AFFIDAVIT <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />RE, QUEST FOR PROPOSALS <br />FOR <br />ON-CALL RIGTIT OF WAY SPECIALTY SERVICES <br />RFP NO.: 15-044 <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 Contact 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 />not 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 fire 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 thereof; or divulged information or data relative <br />thereto, or paid, and will not pay, any fee to arty corporation, partnership, company association, organization, bid depository, <br />or to any member or agent thereof to effectuate a collusive or share bid. <br />Note: The above on -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion <br />thereof shall ars cnstiaute signature of this Non -collusion Affidavit. BIDDERS are an that malting a false <br />certification y I tdteyeertifierto criminal prosecution. <br />Signed <br />State of California k / `" <br />County of Los Angeles <br />Subscribed and sworn to (or affirmed) before me on this •• ° 74 day oft,� 20th by 1) ,1 vi n <br />proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. <br />Notary-Pulihc Signature <br />FARAWHOLANDMUR <br />Couaninlan M rr108446 x <br />WWy Public - California <br />Notary Public SealOT <br />Los Anon CMMV <br />A Calm Eb Ma 27 �16� <br />City of Santa Ana RFP 16-044 <br />Page 28 <br />L A ; C >r <br />