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CITY OF SANTA ANA <br />RFR NO.- 22-133 <br />ON AL L ENQl N EER tNG DE S 113 N -5E RVICE S FOR PFAS TR E ATM E NT SYS TEMS <br />MONyCOLLUSION AFFIDAVIT <br />(Title 23 U n ted States Code Section 112 and P u biic C ontm-cj Code Se ction T f 03) <br />In conformance with Trtliq 23 f.Jnil-ed utwes Code Section 112 and Public Contract Bade <br />7100 ih a -BIRD ER dada rer, th ai the bid is not made in the interest of, or on b eha If Of. a n it <br />Vn(liSCI0_9e(J PerSOri, parinership, company, ass��i�li�r�, neganizallion. or ccrperation; th al <br />the bid i!5 genuine and not collusive or shain- that lire 13MDDFIR has notdinertly or indirecCly <br />induced or solJciled any other BIDDER to prul in a false OF $ham bid, ioiid has not directly <br />or indirec* colluded, -coinspire4, eonnrwed, or agreed wish any BIDDE-R of arnyone else to <br />put in a 5 hara bid, or that anyone shaJl refrain from feud di n:9: that the BIDDER has riot in <br />any manner, directly or indirectly. 913ugJ7t 1)y agreement, communication;, or co illere n-ce <br />with anyone to fix the bid price of Itle BIDDER ar any ci h er BIDDER. c r to fix any <br />over4ead, profit. or Cos9 elernem of the bid price, or of 117at of any other 13I0BER. or to <br />secure sny k wa rrlage agai Rst the public body awa rd ing l h e con trs ct of anyGne interested <br />in the proposed contract; that alJ stataraenle contained in the bid are Irue; and, fkirther, <br />Mal the BiDOER has nil, directly of iridirer-tly, submiNd his or her bid price Dr arey <br />breakd4Avn thereof. or the �nrltenls thtiereaIr. or divulged infonnalion or data reiaiNe <br />thteseto, or paid. and will nod pay, any fee to any corporatlorE, parinership. company <br />a ssociation, orga nirm lion, bid d epcsitory, of to any member ow age n t thereof to effectuate <br />a collusive or sham bid. <br />Note. Th a Above Non -collusion Affidovll iS part -of ttre Proposal. Bla OE R S are <br />cautroned tbat rnakimn:q ;a false certification may subject the cerKier to <br />criminal prose #Jon, <br />Signed <br />Sts to of California f' <br />Cownty of (. )—Ar j <br />S ubscribed and swam C❑ Or affirmed) before me on Chis � day of W 0 L JJ . by <br />. �n --� ,5" , , prayed to me on the WSIS of S03factory evidence to be <br />the person(g) who appeared before me <br />o tui <br />NoJaryr ublic Bigr}alvre Notary Public Seal <br />Mwt� Kom - L11Kwnq <br />tam IPP4AIt7j?Hb <br />+fi+C.arm lbyr.H KV 2r, W�zf <br />S*lyr -of Santa Ana RFP 22-133 <br />Drti- II ENine-ering Design Service-1 for PFA$ Tmaur*mt SyrsLwm <br />Page �$ <br />