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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 16-6461 <br />WARNER INDUSTRIAL COMMUNITY WATER AND SEWER IMPROVEMENTS <br />NON -COLLUSION 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, 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 <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. % A <br />Signed <br />State of California <br />County of b17 -14-161b <br />Subscribed and sworn to (or affirmed) before me on this Volk day of 1 L 20l(L by <br />TAV1VA— UDMe proved to me on the basis of satisfactory evidence to be the <br />person,Kwho appeared before me 9QRNFSSAI.1140RTA9 - 0 <br />COMM. #2066709 <br />_ 19 Notary Pubbe • California <br />n n a z Orange County �+ <br />vV�1 n Comm: kes may 4 201d <br />Not Public Signature Notary Public Seal <br />P-12 OF P-17 <br />