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<br /> 4-64
<br /> CITY OF SANTA ANA
<br /> ATTACHMENT D
<br /> NON-COLLUSION AFFIDAVIT
<br /> (Title 23 United States Code Section 112 and Public Contract Code Section 7106)
<br /> To the CITY OF SANTA ANA
<br /> In accordance with Title 23 United States Code Section 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 undisclosed 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 /> to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived or
<br /> agreed with any proposer or 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 or indirectly, sought by agreement,
<br /> communication, or conference with anyone to fix the proposal price of the proposer or any proposer, or
<br /> to fix any overhead, profit, or cost element of the proposal price, or of that of any other proposer, or to
<br /> secure any advantage against the public body awarding the contract of anyone interested in the proposed
<br /> contract; that all statements contained in the proposal are true; and, further, that the proposer has not,
<br /> directly or indirectly,submitted his or her proposal price or any breakdown thereof,or the contents thereof,
<br /> or divulged 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 agent thereof to
<br /> effectuate a collusive or sham proposal.
<br /> Note: The above non-collusion affidavit is part of the proposal. Signing this proposal on the signature
<br /> portion thereof shall also constitute signature of this non-collusion affidavit. Proposers are cautioned that
<br /> making a false certification may subject the certifier to criminal prosecution.
<br /> /.:.,,
<br /> Signed_s AAAAA,,,, ,,.L;%@::,0-,L.::
<br /> State of' /n 7 1-<2S
<br /> Subscribed and sworn to(or affirmed) before me on this f311:Lday o1 Dec.:fl"/'\ki" 2OA by
<br /> ,_,'°isipmr .. proved to me on the asis of satisfactory eviden e to be the person(s)
<br /> , JACQUELINE VARGAS
<br /> Mnlary Pnhlir•ralifnrnin Z
<br /> I A A Los Arlleles County
<br /> Commission#2496640
<br /> 4,i ,o My Comm.Expires Aug 26,2028
<br /> 11
<br /> foot rva Publ ci State Notary Public Seal
<br /> THIS FORM MUST BE COMPLETED AND JNCLUDFD WITH THE PROPOSAL
<br /> PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE.
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