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CITY OF SANTA ANA <br />PROJECT NO. 09-3214 <br />PROPOSAL AND CONTRACT AGRI_?EIvIENT <br />NON-COLLUSION AFFIDAVTI' <br />('Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106)' <br />To the CPI'Y OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />In accordance with Title 23 United States Code Section 112 and Public Contract ode 7106?the bidder <br />declares that the bid is not made in the interest of, or on behalf of, any undisclosedperson, partnership, <br />company, association, organization, or corporation; that the bid is genuine and n t collusive or sYjam; <br />that the bidder has not directly or indirectly induced or solicited any other bidder to put in a False or <br />sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with airy' bidd?r or <br />anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in <br />any manner, directly or indh-ectly, sought by agreement, comnntnication, or confeFence with auyot}e to <br />fix the bid price of the bidder or any bidder, or to fix any overhead, profit, or colt element of the bid <br />price, or of that of any other bidder, or to secure any advantage against the public body awazding the <br />contract of.anyone interested in the proposed contract; that all statements contained in the b}d aze 'true; <br />and, further, that the bidder has not, directly or indirectly, submitted his or her bid price on any <br />breakdown thereof, or the contents thereof,., or divulged information or data relitive thereto, or paid, <br />and will 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-c lusion Affidavit is part of ttte Proposal. Sigx'ting this Proposal on <br />the signature portion the shall also constitute signature of this non-collusion Affidavit_ <br />Tidders are can tied t x eking a false certification .may subject the certifier to criminal <br />prosecution. <br />Signed <br />D. Cott r - ce res en <br />Subscribed and sworn to before me this <br />21st day of July 20 10 <br />Signed <br />Notary Public <br />NLqtary Seal: <br />g MARY AA? <br />#?1 T612? 51 t <br />Z MOTARy POOLIC - CA?ORWIA I <br />??My oRAN- COt1NTy - TO BE INCL UI3ED! IlN BID PACKAGE <br />Co^vn. Cxph,es Sept. 9, 2011 <br />BP 11 OF 13