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CITY OF SANTA ANA <br /> PROPOSAL <br /> PROJECT NO.: 25-6030 <br /> TRAFFIC SIGNAL INSTALLATION AT SEGERSTROM AVENUE AND ROSEWOOD <br /> AVENUE <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 7106 the <br /> BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed <br /> person,partnership,company, association, organization,or corporation;that the bid is genuine and <br /> not collusive or sham;that the BIDDER has not directly or indirectly induced or solicited any other <br /> BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, <br /> connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall <br /> refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by <br /> agreement, 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 of any <br /> other BIDDER,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, <br /> that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown <br /> thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will <br /> not pay, any fee to any corporation, partnership, company association, organization, bid <br /> depository, or to any member or agent thereof to effectuate a collusive or sham bid. <br /> Note: The above Non-collusion Affidavit is part of the Proposal. BIDDERS are cautioned <br /> that making a false certification may subject the certifier to criminal prosecution. <br /> Signed <br /> State of California <br /> County of <br /> Subscribed and sworn to (or affirmed) before me on this day of , 20 , by <br /> ,proved to me on the basis of satisfactory evidence to be the person(s) <br /> who appeared before me <br /> Notary Public Signature Notary Public Seal <br /> P-12 ofP-19 <br />