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(A4) Acquisition /Relocation <br />APPENDIX <br />ATTACHMENT 3 -1: NON - COLLUSION AFFIDAVIT <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL RIGHT 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 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, comiived 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 marmer, 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 thereof, or divulged information 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 shall also constitute signature of this Non - collusion Affidavit. BIDDERS are cautioned that making a false <br />certifip do may subject the certifier tdZ4gninal prosecution. n <br />Signed <br />State of 0 <br />County of <br />Subscribed and sworn to (or affirmed) before me on this _!I_ day of,5U 6. , 20_15 by ybN�5 L. pl/O�6AU11P Z rZ <br />proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. <br />Notary ublic Seal JESUS ORTIZ <br />Y COMM. #1969100 m <br />NoInN tar <br />PW�Ca nls <br />LOB ANULES COUPRV <br />W <br />0M Cam B 9. 2010 <br />City of Santa Ana RFP 15 -044 <br />Page 28 <br />