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TO BE INCLUDED IN PROPOSAL <br />EXHIBIT G <br />CITY OF SANTA ANA COMMUNITY DEVELOPMENT <br />REQUEST FOR PROPOSALS FOR ENVIRONMENTAL SERVICES HOUSING DIVISION <br />PROPOSAL AND CONTRACT AGREEMENT <br />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, <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the PROPOSER <br />declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, <br />association, organization, or corporation; thatthe bid is genuine and not collusive or sham; that the PROPOSER <br />has not directly or indirectly induced or solicited any other PROPOSER to put in a false or sham bid, and has <br />not directly or indirectly colluded, conspired, connived or agreed with any PROPOSER or anyone else to put in <br />a sham bid, or that anyone shall refrain from bidding; that the PROPOSER has not in any manner, directly or <br />indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the <br />PROPOSER or any PROPOSER, or to fix any overhead, profit, or cost element of the bid price, or of that of any <br />other PROPOSER, or to secure any advantage against the public body awarding the contract of anyone <br />interested in the proposed contract; that all statements contained in the bid are true; and, further, that the <br />PROPOSER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the <br />contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any <br />corporation, partnership, company association, organization, bid depository, or to any member or agent thereof <br />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. PROPOSERS are cautioned <br />that making a false certification may subject the certifier to criminal prosecution. <br />State of California <br />County of Los Angeles <br />Subscribed and sworn to (or affirmed) before me on this day of 20 2;1 , by <br />_ Deanna Hansen proved to me on the basis of satisfactory evidence to be the person($) <br />Sio... <br />who appeared before me, AN ANt11fRSON <br />Comm, .t2219154 z <br />%RASHIDAJOCE <br />[votary Public California q <br />zLos Angeles Countyy <br />My Comm. Expires Oct 2I, 20A <br />otary Public Signature Notary Public Seal <br />City of Santa Ana Community Development Agency <br />Request for Proposals •Environ mental Services — Housing Division <br />Page 18 <br />