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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECC'NO. 11-6740: BRISTOL STREET IMPROVEMENTS AND WIDENING FROM <br />WASHINGTON AVENUE TO 17Tri STREET <br />PROJECT NO. 17-6472: BRISTOL STREET WATER MAIN IMPROVEMENTS FROM <br />WASHINGTON AVENUE TO 17"' STREET <br />PROJECT NO, 17-6473: BRISTOL STREET SEWER MAIN IMPROVEMENTS FROM <br />WASHINGTON AVENUE TO 17TH STREET <br />NON -COLLUSION AFFIDAVIT <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 Contact 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 />contact 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 Noncollusion Affidavit is part of the Proposal. BIDDERS are <br />cautioned that malting a false certification may subject the certifier to criminal <br />pposeQutioli. <br />Signed _.._. _.._ <br />Aaron 0 Brien, Secretary <br />State of California <br />County of <br />Subscribed and sworn to (or affinned) before me on this day of , 20_, by <br />, proved to me on the basis of satisfactory evidence to be the <br />person(s) who appeared before me <br />See Attached Notary Acknowledgement <br />Notary Public Signature Notary Public Seal <br />P-16 of P-21 <br />23A-35 <br />