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City of Santa Ana I California <br />Required Forms <br />Non-Collusion Affidavit <br />CITY OF SANTA ANA. <br />RPP NC.: 16.072 <br />USER. PEE STUDS` <br />NON -ML LU,,,, L JS 9kiATRfUAV1'f <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106 <br />In conformance with Title 23 United States Code Section 112 mid Public Contract Code 7106 the <br />BIDDER declares dint the bid is not made in die interest of, or on behalf of, may undisclosed <br />person, partnership, company, association, organization, or corponaian; that the bid is genuine <br />and not collusive or $Ian%; that the BIDDER has not directly or Indirectly induced or soliefted <br />any other BIDDER to pm in a false or sham bid, and bas 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 may overhead, profit, oncost element of time bid price, <br />orordmnt orany other BIDDER, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statement% contained in the bbd are <br />true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price <br />or may breakdown thereof, or the contents thereof; or divulged information or data relative <br />thereto, or paid, and will not pay, any tee to any corporation, partnership, company association, <br />organization, bid depository, or to any member or agent thereof to effectuate a collusive orshmim <br />bid. <br />Note: The above Non - collusion Affidavit is pan of the Proposal. BIDDERS are <br />cautioned drat making a false Certification may subject die certifier to criminal <br />Signed <br />State am <br />County of <br />Subscribed and swo to (or affirmed) before me on this day or 2o—, by <br />proved to ale on the basis of satisfactory evidence to be the <br />porson(s) wlto appaared biro a <br />Notary Public Signature <br />Public Seal <br />Comprehensive. Innovative. "Il rusted. 24 City of Santa Ana <br />7.111 1 User Fee Study <br />250 -27 <br />