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CITY OF SANTA A A <br />ATTACHMENT D <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Cade Section 7106) <br />To the CITY OF SA NTA ANA <br />In accordance with Title 23 l nded States Code Seclion 112 and Public Contract Code 7106 the proposer <br />declares that the proposal is not made in the interest of, or on behalf of', any undiscilosed person,. <br />partnership, company, association. organization, or corporation; that the proposal is genuine and not <br />collusive or sham, that the proposer has not directly or indirectly induced or solicited any other proposer <br />10 put in a false or sham proposal, and has not directly or indirectly coiluded, conspired, connived or <br />,agreed with any proposeor anyone else to put in a sham proposal, or that anyone shall refrain from <br />bidding; that the proposer has not in any manner,, directly of rncirreclly. sought by agreement. <br />c€r'mmunication, or conference with anyone to fix the proposal price of the proposer or any proposer, or <br />to fix any overhead, profit, or cast element of the proposal price, or of that of any other proposer, or to <br />secure any advantage against the public body awarding the contrad of anyone interested in the <br />proposed contrad. that all statements contained in the proposal .are true, and. further, that the proposer <br />has Trot, directly or indirectly, submitted his or her proposal price or .any breakdown thereof, or the <br />Contents thereof, or divulged information or data relative thereto, or paid, and % ll not pay, any fee to any" <br />corporation. partnership, company association, organization, bid depository, or to any member or agent <br />thereof to effectuate a collusive or share proposa'I. <br />Mote, The above non -collusion affidavit is part of the proposal, Signing this proposal on the signatwre <br />portion thereof shall also constitute signature of this non- ilusion affidavit, Proposers are cautioned thiat <br />making a false certification may subject the certifier to criminal prosecution. <br />State of V fJ County of <br />9 bscr' ed nd sworn to (or affirmed) before me on this 1A day of � lJN , 20 '�i , by <br />Q , proved to me an the basis of satisfactory evidence to I} the person(s) <br />who appeared before me- <br />CIS13,12.5 <br />Notary Public Seal <br />THIS FORM (MUST BE COMPLETED AND INCLUDED WITH FHE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City Council <br />23 — 73 8/6/2024 <br />W <br />