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25I - AGMT - WALNUT PUMP STATION
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25I - AGMT - WALNUT PUMP STATION
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Last modified
9/14/2017 5:53:57 PM
Creation date
9/15/2017 1:05:03 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
25I
Date
9/19/2017
Destruction Year
2022
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Exhibit C <br />3-1 NON -COLLUSION AFRDAVIT <br />Appendix <br />ATTACHMENT 3.1; NON -COLLUSION AFFIDAVIT <br />CERTIFICATIONS <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />In accordance with Title 23 United States Coda Section 112 and Public Contract Code 7106 the BIDDER declares <br />that the bid is not made in the Interest of, or an behalf of, any undisclosed person, partnership, company, association, <br />organization, or corporation; that the bid Is gamine and not collusive or sham; that the BIDDER has not directly or <br />Indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or Indirectly <br />colluded, conspired, connived or agreed with any BIDDER or anyone else to put In a sham bid, or that anyone shall <br />refrain fican bidding; that the BIDDER has not in any manner, directly or Indirectly, sought by agreement, <br />communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any <br />overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against <br />the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in <br />the bid are ane; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or nay <br />breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, <br />any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent <br />thereof to effectuate a collusive or sham bid. <br />Note: The above Non -collusion Affidavit is pmt of the Proposal. Signing this Proposal on the signature <br />portion thereof shat also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that <br />making a false certifrlonation may��subjeect the certifier to criminalproseoutim. <br />Signed Aw ! / J( 17ayta IyIlenek <br />State of California <br />County of Orange <br />Subsodbed end sworn to (or affirmed) before me on this S day of f� rs( it . 201 by <br />afore Ni kn.f5 proved to me on the basis of satisfactory evidence to be the person(s) who appeared <br />before me, <br />77cA+ <br />Notary Public Signature Notary Public Sent <br />Walnut Pump Station and San Lorenzo Sewage Lift Station I City of Santa Ana <br />City of Santa Ana RFP <br />Page AM <br />251-18 <br />)h NATHAN LOPEZ <br />Commission # MGM z <br />-m e, Notary Mile - California <br />orange County <br />M Comm. Ex Ires se 2B 201C+ <br />23 <br />
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