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0 <br />City of Santa Ana <br />ITEM 16: NON -COLLUSION CERTIFICATION <br />The undersigned hereby certifies on behalf of ("Proposer"), and <br />hereby declares under penalty of perjury under the laws of the State of California, that <br />this (TBD) EMS 9-1-1 Emergency Transportation Service RFP is genuine and not sham <br />or collusive, nor made in the interest of or on behalf of any person not herein named; the <br />Proposer has not directly or indirectly induced or solicited any other Proposer to put in a <br />sham proposal nor solicited any other person, firm or corporation to refrain from <br />submitting a proposal; the Proposer has not communicated, directly or indirectly, with any <br />other Proposer regarding the amount, price, and/or service rates proposed herein; and <br />Proposer has not in any manner sought by collusion to secure for himself/herself/itself <br />any advantage over any other Proposer. We declare the foregoing is true and correct <br />under penalty of perjury under the laws of the State of California. Signed, this <br />day of -2018 in <br />California. <br />IF SOLE OWNER: <br />Signature of Owner Date <br />Print Name <br />IF PARTNERSHIP (JPA or merger): <br />Signature of Partner (General Partner) Date <br />Print Name <br />IF CORPORATION: <br />Signature of President Date <br />Print Name <br />Signature of Secretary Date <br />Print Name <br />City of Santa Ana Page 189 <br />Fire/EMS Emergency Ambulance Transportation and Related Services <br />Request for Proposals: # 18-059 <br />August 28, 2018 <br />WO I 'F <br />