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REQUIRED FORMS APPENDIX <br />CERTIFICATIONS <br />NON -COLLUSION 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 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, or 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 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 making a f se certification may subject the certifier to criminal prosecution. <br />State of Calf rnia <br />County of <br />Subscribed and sworn to or affirmed) before me on this I ib day of, 20 1-7, by <br />s. SOO J9W., proved to me on the basis of satisfactory evidence to be <br />the persoft s) who a peared before me <br />Notary Public Seal <br />;I •.^�^`— <br />DESIREE KEYES <br />Commission w 2104505 <br />Notary Public • California <br />Orange county 5 <br />mm. Expir_ r T 19. E0r9 <br />Page I of 2 <br />