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i <br />0001 <br />i -ATTACH <br />Ni foxAsir i Dn rIT <br />4 L aTiona, <br />(TA1023 WtOd Win "Soollon 112end <br />Public Contract "a Sw9nolm) <br />To to CITY OF SANTA ANA DEPARTMW 011 MMIr, WORD <br />Ih accordance with Tide 23 United States Cc& Section 112 end public Cactw " 7196 the BIDDER dacbras <br />that the bid Is sot made In the interest bf, or Oftbahalf, of, any Undisclosed perno% parlsersbiji. companypealati <br />.A on, <br />049AWAstion, or wrp"ma; that the bid to genuine and not collusive or sham; that do BMM has ad dreptly or <br />lndh* induced or solicited Any other BIDDER to put In a Me at ohm bid, and hes not directly or bidlre4y <br />B R <br />�DE arm"a"O"", pu'"dirac9Y or :�"` <br />0 <br />"'neom <br />sanfraot tient all 6"'cona's <br />O'c", <br />0011, <br />7ipat the MM hes not <br />'4 w <br />or <br />cc� to il� the bid <br />or conference <br />Tram 7o Ogtof bi <br />Winded bed, arttteisrgvcne Ono <br />in soagbt. by out <br />uWas"' fix any <br />th" sonst <br />an <br />y "Md <br />ofthe Ou <br />onc'�W ""e' <br />the publica tZ of �e <br />W4� <br />Bed in <br />bit! aro <br />end, <br />Wh t the 13113�7 his ri� ditenti ot"Whae"' or.Auv <br />the 740.1 y <br />the <br />b And"111 " pay, <br />W�WW enship, oempWasseciati or*nt <br />ficn� acilW 0or shaaOM4 <br />NOW The above Non -cohesion Affidavit Is part of Hie Proposal, Signing this pipposal on the sigaidme, <br />POAHOU thereof shelf WOO 0011SUM 51FOUM) Of this Allidat MDDM are mdo& that <br />1110drisit Mw cerifficallon may subjedthe cartifter to o4minal pwejuttov, <br />Signed <br />state of CAHfornla <br />County of <br />Subscribed and aware to (or 'atifirmed) before me on this —day of 20� by <br />proved to me on die basis of sellsf evldonce to be the pwonns) who appeared <br />bofarame. <br />Notary Publio Sod <br />CRY ; USinto ATM' <br />Page A3.1 <br />25E-788 <br />a <br />