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APPENDIX <br />ATTACkIMEN7' 3 -1: NON-COLLUSION AFFIDAVIT <br />CERTiFIC'AT1nNS <br />CITY Ole SANTA ANA <br />REQUEST FOR PROPOSALS <br />1- {ill. <br />WALNUT PUMP STATION C71'L^'•i1ATIONAL PLAN AND SYSTEM TESTING <br />IWP NO.: 15 -105 <br />NON- C()I.I.I Sl0N AfTIDANIT <br />Cutts 23 United States Code Section 1 12 and <br />Public Coawwt Code 5cction 71061 <br />T'o the C.1-fY or SANTA ANA L)HP,AR'i'trIUNT C)f PUBLIC WORKS <br />In accondance wiih •Title. 23 United Swes Oide. Section 112 acrd iruhhc, C'ontzact Code 'l 06 the BIDDER. declares that the hid <br />is not made in the interest of, or on behalf or, any undisclosed person, parmaship, company, association, orsrrnirnliou, or <br />corporation; thin the laid is guanine and not collusive or sham; that 11w BIDDER has riot directly or indirectly inducted or <br />solicited any other BIDDER to .put in it false or sham bid, and has nor directly of indireelly colluded, con;,pirul, connived or <br />agocd with any BFLat1hR or anyone else to ptil in a sltatn bid, or that anyone shall refrain from bidding; that the BIDDER has <br />not in any ntanner, dircv:tiy 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 my overhead, profit, or cast element of the hid price, or of that of any other <br />13[1)DER, (it' to secure any advantage against the public booty awvartling the eontruct of anyone interested in the proposed <br />contract: that all statertionts eoin alvicd in the bid ire true; 'and, fInTher, that the Bf1)F)TR has not, dircetly err indirmly, <br />a,ubndlted his or her hid price or any hn�mkdown them', or the consents therwC, or divulged information or data relative, <br />thereto, or paid, tine) will not pay, any fee to any corporation, par'hrciship, compaarty association, 01gartiVACK1 hid depositrotyt, <br />or to any member or £Ygenl. 1'herc'rl 10 effeCILIale as collnSiVe OYSIiarhl hid, <br />Nolte: The above Non- c:ollusion Affidavit 1, pant of the Proposal. Signing this Proposal on floc 6i}_nn1111re pattion <br />tlneceof shltll tnlso c r>srifu9e signatu of Ibis dean- ccfliusion ARrd£awit, BIDDHRS are c titioned Ilia[ making a fake <br />oertikiltion tray subjet:l'the certifier to crituin.al pixnscr. utivm. <br />Signed <br />State of C"alitirrnia <br />County of <br />Subscribed and sworn In (or aflirtned) before me on this -_ __ day of , 2(_, by <br />proved to une on the basis oCsatis lactoay evidonac to be tine persons) who appeared before one. <br />Notary Public Signature Nolrary Public Sent. <br />City of Santa Aria R77,77 <br />2 Ui t4 <br />