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CITY OF SANTA AICA <br />PROPOSAL <br />PROJECT NO.: 16-267 1 <br />BON10 KOR.AL SIDEWALK IUNOVATION <br />NON -COLS: USiON AFFIDAVIT <br />(Title 23 United States Code Section 1.12 mid <br />Public Contract Code Section 7106) <br />In accordance with Title 23 United States Code Section 1.12 and Public Contract Code 7106 -die <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 germine <br />and not collusive or sham; that the BIDDER bas not directly or indirectly induced or solicited <br />any other BIDDER to put in a false or shatu bid, and has not directly or indirectly colluded, <br />conspired, connived or agreed with any BIDDER or arnyoue else to put in a sham bid, or that <br />anyone shall refrain from bidding; that alae BIDDER. Ims not in any inannec, directly ov indirectly, <br />sought by agreement, communication, or conference with anyone to fix the laid price of the <br />BIDDEN or any BIDDER, or to.fix any overhead, profit, or cost element of the bid price, or of <br />that of any other BIDDER, or to secure any advarntage against the public body awarding the <br />contract of anyone interested in the proposed contract; that a]l statements' contained in the bad Eve <br />true; and, firrther, that the BIDDER has not, directly or indirectly, submitted his or her bid price <br />or any breakdownthereof, or the contents thereof, or divulged information or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partnncvship, company association, <br />cargan.izatiort, bid depository, or to any member or agent thereof to effectuate a collusive or shann <br />laid, <br />Note; The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal <br />can the signature poi,lim thereat' shall also constitute signature of this Non -collusion <br />Affidavit. BID are ud ed that making a false certification in.ay subject the <br />0ertifier to crit "lilt pros Li op, <br />Signed <br />Stet" California <br />County —of, <br />Subscribed and s) <br />or affirmecl) before me tin this <br />,'rived to rule on the basis <br />person(s) who appeared before me <br />Notary Public Signature <br />day of , 20--_, by <br />of satisfactory evidence to be 'tine <br />Notary Public <br />