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CITY OF SANTA AMA <br />RFA NO.: 22-133 <br />ON -CALL ENGINEERING, DESIGN SERVICES FOR PFAS TREATMENT SYSTEMS <br />NON-CDLLUSIGN AFFIOAV17 <br />(Title 23 United States Cade Section 112 and Public Contracl Code Section 7106) <br />In conformance with Title 23 UnitedStates Code Sectiofi 112 and Public Contract Code <br />7106 the BIDDER declares that the bid is not crude in Lfie interest of, or on behalf of, any <br />uhdisclosedperson, partnership, Company, association, organization, or corporation: that <br />the bid is g®nuine and not collusive or sham; that the BIDDER has not directly or indirectly <br />induced or solicited any other BIDDER to put in a false or sham bid, and had not directly <br />or indirectly colluded, conspired, connived, of agreed witii any BIDDER or anyone Elise to <br />put iv a sllarn bid, or that anyone Shall refrain from bidding; that the BIDOElR has not in <br />any manner, directly or indirectly, sought by agreement. communication, or +conference <br />with anyone to Fix the bid prier' of the BIDDER or any other BIDDER, or to fix any <br />overhead, profit, or Cost element of the bid price, or of that of any other BIDDER, or to <br />secure any advantage against th® public body awarding the Contract of anyone interested <br />in vie proposed contract; that all statements contained in th® bid are tfue; and, further, <br />Mal the $11DDER has not, difeetly or indirectly, submitted his ar her bid price or any <br />breakdown [hereof, or the conlents thereof, of divu6ped information or data relative <br />therela, or paid, and will not pay, any fee to any corparation, partnership. Company <br />association, organization, bid deposilory, or to any member or agent thereof to effectuate <br />a Collrisibe or sham bid. <br />Note: The above Non -collusion Affidavit is part of the proposal. UDDERS are <br />cautioned that making a false certification may Subject the Certifier to <br />crir»irtal prosecution.� <br />Signed <br />State of California County of SQa d5 %e'64'-rL-qj <br />Subscri ed and sworn to qar affirmed) before me on this BY of,L 2fk!' by <br />PeAffi UJ OzI proved to me on the basis of Saflsrectory evidence to be <br />the persons) who appeared before me <br />SEE NOTARY <br />✓ ATTACHED <br />Notary Public Signature Notary 1341i.0 Seal <br />City of Santa Ana RFP 22-133 <br />mn-Call Fngtltmaring Os@ign 8ariir, r, Tor PFAS Tree;ment Syrtsm <br />City Council - 19 — 280 4/4/2023 <br />