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CITY OF SANTA ANA <br />PROJECT <br />N 16-6467 <br />A <br />Sla <br />JY f PROPOSAL <br />. A OS V y <br />(ADDENDUM <br />. ti ® #.,—JULY 22, i. K <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 <br />7106 the BIDDER declares that the bad is not made in the Interest of, or on behalf of, <br />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 <br />directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, <br />,and has not directly or indirectly colluded, conspired, connived or agreed with any <br />BIDDER or anyone else to put in a sham bid„ or that anyone shall refrain from bidding; <br />that the BIDDER has not in any manner, directly or Indirectly, sought by agreement, <br />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 bidprice, or of that of any <br />other BIDDER, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained In <br />the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted <br />his or tier bid price or any breakdown thereof, or the contents thereof, or divulged''. <br />information or data relative thereto, or paid, and will not pay, any fee to any corporation, <br />partnership, company association, organization, bid depository, or to any member or <br />agent thereof to effectuate a collusive or sham bid, <br />Note: The above hien-collusion Affidavit is part of the Proposal. Signing this <br />Proposal an the signature portion thereof shall also constitute signature of this <br />Non-colluslon Affidavit. BIDDERS are cautioned that making a false certification <br />may qubjectrthp certifier to criminal prosecution. <br />Signed i u_4 s <br />1 <br />State of California <br />County of a z_ -at it GE <br />Subscribed and sworn to for affirmed) before me on this day of __, 20. , <br />by proved to me on the basis of satisfactory evidence to <br />be the person(s) who appeared before me <br />Notary Public Signature Notary Public Seal <br />City of Santa Arta P Project 16-646Y ; lMa Ani�Ur jrdf i t ri vemon Project 1 REBID - October '1 2016 <br />