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UMMLAMPAY—IT <br />(Title 23 United States Code Section 112 and <br />Public ODAMMI Code Section 7106) <br />TO the CITY OF SAM ANA USPARThOM OF PUBLIC WORKS <br />In accordance with Title 23 United States Code Section 112 and Public CDnt=t Code 7106 the BIDDER declares <br />that the bid is not made to tic interest of, or on behalf of, any undisclosed person, prwinership, company, association, <br />n gersdas oand not collusive or sham, that the, BIDDER has not directly or <br />ad that the hI, is <br />an 0 BIDDER tapat I <br />007 1 `V'� MYBWDM <br />0 ER no ! in my <br />oft y lae <br />'M"o" r rp 0 <br />d <br />�Va <br />rathe I In ph or a <br />at� co <br />c nedd con' d r <br />1 7 to Put In a Me or sham bid, and has not directly or indirectly <br />R I biddi B or anyone also to put in a sham bid, or that anyone shall <br />ot n a u&I dis' "a I In any manner, dirced y or Indirectly, sought by agreement, <br />0 asece W, anyone to fix ft bid <br />r I oflo , or the bid Price of theM)DER or any BIDDER, or to fix any <br />an as <br />am cad, pmftt, or cot element of the "'i Vloa� or orthat I <br />t he bli b orthat ofany other BIDDER, or to secure any advantage against <br />4 a wy alvardioll the contract Of anyone Interested <br />W rested in the proposed cantract; that all statements contained in <br />p tr . <br />am ac� 80 , narther, Mat the BIDDER has u04 dil <br />'n t re tents he co n*4 directly or Indireany, submitted his or her bid price or any <br />a <br />bmakkdowwn iereo or the contents thereof, or divulged Imbrication or data relative thereto, or paid, and will not pay, <br />con <br />any fee to any corporation, partnershipi company association, organization, bid depository, or to saw member or agent <br />thereof to offiectuate a collosive or sham bid. <br />Note: Tile above Non-collualon Affidavit is part of the proposal. Signing this Proposal on tile signature <br />pordflon t er also constitute siganala) Ofthis N011-collusion Affidavit. BIDDERS are cautioned that <br />' os" <br />ard 0"Om b, t h In not prosecution, <br />makin a on in <br />Signed _ r= <br />State Of a <br />County of <br />Subscribed and swern to Z&�Qbllaed) before me on this — day of <br />1G,m _� 20� by <br />proved (a e-o the bags of satisfactory evidence to be the p�=—n—(s) who appeared <br />Wore �lno. <br />Ro-fary �PublicSlgnatave <br />SwAttarhaar <br />fttalY Publk' Doewnent <br />Notary Public Seal <br />25E-639 <br />