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(9) City of Santa Ana <br />ITEM 16: NON - COLLUSION CERTIFICATION <br />The undersigned hereby certifies on behalf of ( "Proposer "), and hereby <br />declares under penalty of perjury under the laws of the State of California, that this (TBD) EMS 9 -1 -1 <br />Emergency Transportation Service RFP is genuine and not sham or collusive, nor made in the interest of <br />or on behalf of any person not herein named; the Proposer has not directly or indirectly induced or <br />solicited any other Proposer to put in a sham proposal nor solicited any other person, firm or corporation <br />to refrain from submitting a proposal; the Proposer has not communicated, directly or indirectly, with any <br />other Proposer regarding the amount, price, and /or service rates proposed herein; and Proposer has not in <br />any manner sought by collusion to secure for himself/herself /itself any advantage over any other <br />Proposer. We declare the foregoing is true and correct under penalty of perjury under the laws of the <br />State of California. Signed, this day of , 2012 in _ <br />, California. <br />IF SOLE OWNER: <br />Signature of Owner <br />Date <br />Print Name <br />IF PARTNERSHIP UPA or merger): <br />Signature of Partner (General Partner) <br />Date <br />Print Name <br />IF CORPORATION: <br />Signature of President <br />Date <br />Print Name <br />Signature of Secretary <br />Date <br />Print Name <br />Phase 2 RFP: Emergency Ambulance Transportation and Related Services Page 174 <br />June 14, 2012 <br />25F -93 <br />