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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.09-3213 <br />CENTENNIAL PARK NEIGHBORHOOD WATER MAIN IMPROVEMENTS <br />NON-COLLUSI N 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 <br />person, partnership, company, association, organization, or corporation; that the bid is genuine <br />and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any <br />other 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, <br />that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown <br />thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will <br />not pay, any fee to any corporation, partnership, company association, organization, bid <br />depository, orto 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 <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 criminal <br />prosecution. , <br />Signed <br />State of California <br />County of DrA <br />Subscribed and sworn to (or affirmed) before me on this IlNay of _FPS?_, 20� by <br />S'kari. r proved to me on the basis of satisfactory evidence to be the <br />person(sfwho appeared before me t` comm' UA�� -Act C s <br />Notary Public • California o <br />z Orange County <br />Comm. Ex fires Jul 13, 2016LL <br />Notary Public Signature Notary Public Seal <br />P-t0 ofP-1.5 <br />23A-18 <br />