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REQUIRED FORMS APPENDIX
<br />CERTIFICATIONS
<br />NON- C01 ,r.USIO9' AFFIDAVIT
<br />(Title 23 United States Code Section 112 and Public Contract Code Section
<br />7106)
<br />In conformance 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 share; that the BIDDER has not directly or indirectly induced or solicited
<br />any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded,
<br />conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that
<br />anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly,
<br />sought by agreement, communication, or conference with anyone to fix the bid price of the
<br />BIDDER or any other BIDDER, or to fix any overhead, profit, or cost clement of the bid price,
<br />or of that of any 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 the bid are
<br />true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price
<br />or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto,
<br />or paid, and will not pay, any fee to any corporation, partnership, company association,
<br />organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham
<br />bid,
<br />Note: The above Non- collusion Affidavit is part of the Proposal, BIDDERS are cautioned
<br />that snaking a se certification may subject the certifier to criminal prosecution.
<br />State of Calf rnia
<br />County of .
<br />Subscribed and .warn to or affirmed) before tneon this-& ,,,day of;_ , 20r`f, by
<br />.# , proved to me on the basis of satisfactory evidence to be
<br />the persrfi who a pc;areci before me
<br />Notary Public Scal
<br />f,BIRCC KEYES
<br />CommI$$Jon wl 2104505
<br />Notyty Publkr, Cajltornl4
<br />mange country n
<br />I'�.. .. 1y_Commw(ixultert�,2U�y'>
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