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CITY ®F' SANTA ANA <br />RFP NO,; 16 -074 <br />DEVELOPMENTIMPACTF'EES <br />�V -CQ9)( F.UJ�9d9N AF'1!IdAAVIT <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 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 <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, er to fix any overhead, profit, or cost element 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 <br />thereto, 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 <br />cautioned that making a <br />prosecution, false certification may subject the certifier to criminal <br />Signed <br />State of Q <br />County of <br />Subscribed and sworn to <br />person($) who appeared �p before me <br />Notary Public Signature <br />d) before me on day of 20.w by <br />to me on the basis of atisfactory evidence to be tho <br />25P -23 <br />Seal <br />Page 1 of 1 <br />