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a <br />Appendix <br />ATTACHMENT 4-1: NON -COLLUSION AFFIDAVIT CERTIFICATIONS <br />WATER RESOURCES RIGHT OF WAY ACQUISITION SERVICES <br />RFP NO.: 20-091 <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Cade 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 Cade 7106 the BIDDER declares <br />that the bid is not made in the interest of or on behalf of, any undisclosed person, partnership, co npany, association, <br />organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has rot 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; did 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 no, directly or indirectly, submitted his or her bid price or any <br />breakdown thereof, or the contents tlxaeof, or divulged information er data relative thereto, or paid, and will not pay, <br />any fee to any corporation. partnership, connpeny association, organization, bid depository, or In 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 signore of this Non -collusion Affidavit BIDDERS are cautioned that <br />making as false certification may subject the certifier to criminal prosecution. <br />Signed . r/s�,, <br />State of California <br />Cartnttyy of <br />Subscrtc 'bb and sworn to (or affirmed) before ne \dq this day of . 20_, by <br />proved to me on the basis of satis evidence to be the person(s) who appeared <br />before me. <br />llotary Public Signature <br />Notary Public Seal <br />Qty of Santa Ana RFP 20-091 <br />Page A5-1 <br />FROPOSALTO CITY OF SANTA ANA. RFP 20-09125D-242 <br />129 <br />