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APPENDIX ATTACHMENT D-1: NON -COLLUSION AFFIDAVIT CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR ON -CALL ENGINEERING SERVICES RFP NO.: 14.037 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or Indirectly induced or solicited any other BIDDER to put In a false or sham bid, and has not directly or Indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price 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 BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested In the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The hbovq Nan-collusIf'' fiidavit is part of the Proposal. Signing this Proposal on the signature portion ther of sh II also copgtitu o signature of this Non-colluslon Affidavit. BIDDERS are cautioned that making a f e ce ificatlon ay eject the certifier to criminal prosecution. Signed — j_ / — State of California County of brA Subscribed and sy orn to (or affirmed) before me on this day of }\IoUPtck 20,f, by lbayr'% proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. EMMA SCRTC Commis®Inn # 1SS71A5 ® Notary Public - California Las Angeles County M Comm. Ex iron Jen 21, 2015♦ Notary Public Signature Notary Public Seal THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP 14-037 Page 26