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City of Santa Ana i California <br />Required Forms <br />Non -Collusion Affidavit <br />CITY Or SANTA ANA <br />RFP NO.: 16-072 <br />USER PEE STUDY <br />NC2N-CCtLLUSIUN AFFIDAVIT <br />(Title Ll United States Code Section 112 And Public Contract Code Section 7106) <br />In conformance with Title 23 United States Coda Section 112 acid public Contract Code 7'106 the <br />BIDDER declines; (Ind the bid is not made in the interest of, or on behalf of, any undisclosed <br />person, Partnership, company, association, organization, or corporation; that ilia bid is Soluble <br />and not collusiver or $limit; that the BIDDER has not directly or indirectly induced or solicited <br />any other BIDDER to Pat in a false or shunt hK and has out directly or indirectly colluded, <br />conspired, comilved, or asoned with any BIDDER or anyone else to put in a sham bid, or that <br />anyone shall refrain &am bidding; that ilia BIDDER has Italia any marmar, directly or indirectly, <br />sought by agreement, atiammincinion, or coriffestorice with anyone to fix the bid price of the <br />BIDDER or any other BIDDER, or to fix any overhead, prolit, oncost element of the bid price, <br />or of That of any other BIDDER, or to secure any advantage agausit the public body awarding the <br />contract of anyone interested in the proposed contract; that all sunterrumm contained in The bid are <br />into; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price <br />or any breakdown thenarif, 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 racrubor or agent theratif to c[Toctuate a cullimivo or ilium <br />bid. <br />Note: 'The above Noa•colhlsiocAffidavit is poll of the Proposal. BIDDERS are <br />cautioned that nardillig a false certification may subject thit cortifier to criminal <br />prcrsocuti Y"'" <br />Signed I <br />State o lifornia <br />Couttly Of <br />Subscribed and sNvdhqo (or affirmed) before me on this day of 20, by <br />Notary Public Signature <br />proved to Ind on the basis of satisfactory evidence to be the <br />Public Seat <br />Comprehensive. Innovative, Frusted. 24 City of Santa Ana <br />'I User Fee Study <br />