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CITY OF SANTA ANA <br />RFP NO.: 21-122 <br />ON -CALL ELECTRICAL REPAIR AND REHABILITATION SERVICES <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br />In conformance with Title 23 United States Code Section 112 and Public Contract Code <br />7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, <br />any undisclosed person, partnership, company, association, organization, or <br />corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not <br />directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, <br />and has not directly or indirectly colluded, conspired, connived, or agreed with any <br />BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; <br />that 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 <br />other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that <br />of any other BIDDER, or to secure any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained in <br />the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted <br />his or her bid price or any breakdown thereof, or the contents thereof, or divulged <br />information or data relative thereto, or paid, and will not pay, any fee to any corporation, <br />partnership, company association, organization, bid depository, or to any member or <br />agent thereof to effectuate a collusive or sham bid. <br />Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are <br />cautioned that making a false certification may subject the certifier to <br />criminal prosecution. <br />Signed <br />State of California <br />County of D y'a p- <br />ci <br />�V, <br />Subscribed and sworn to (or affirmed) before me on this-YN day of ❑ 2fl2 <br />by cA , proved to me on the basis of satisfactory evidence to <br />be the person(s) who appeared before me <br />Notary Public Signature <br />Notary Public Seal <br />KATHREEN KUK <br />Comm, #2221981 x <br />Public California <br />' <br />Notary - <br />a <br />x :•.,• <br />0range County <br />M Comm. Expires Nov. 16, 2421 <br />City of Santa Ana RFP 21-122 <br />On -Call Electrical Repair and Rehabilitation Services <br />Pape 34 <br />