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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 Code Section 112 and Public Contract Code 7106 the BIDDER declares <br />that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, <br />organization, or corporation; that the bid is genuine 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 from 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 true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any <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 part of the Proposal. Signing this Proposal on the signature <br />portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that <br />making a false certification may subject the certifier to criminal prosecution. <br />Signed <br />State of California <br />County of <br />Subscribed and sworn to (or affirmed) before me on this _ day of . 20, by <br />, proved to me on the basis of satisfactory evidence to be the person(s) who appeared <br />before me. <br />Notary Public Signature <br />Notary Public Seal <br />City of Santa Ana RFP <br />Page A3-1 <br />25A-33 <br />