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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL RIGHT OF WAY SPECIALTY SERVICES <br />RFP NO.: 13 -075 <br />NON- COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER <br />declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, <br />association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER <br />has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has <br />not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a <br />sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or <br />indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or <br />any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, 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 bid are true; and, further, that the BIDDER has not, directly or <br />indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged <br />information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company <br />association, organization, bid 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. Signing this Proposal on the signature portion <br />thereof shall also constitute signature of this Non - collusion Affidavit. BIDDERS are cautioned that making a <br />false certificgtign may subject the certifier to criminal prosecution. <br />Signed <br />State of Calif rnia <br />County of <br />Sub $ir}q d and s� wgrn to (or ffpv ed) before <br />r 1,� y o or roved to me <br />appeared before me. <br />me on this M/W day of ^' 20 , by <br />on the basis of satisfactory evidence to a the person t) who <br />Notary Public Seal <br />r•• <br />FNOTCA0VMMeJL1C ED JATTALA <br />2tl12173 <br />$ALIFOANIA NC OUNTY ENP. MGM, i�, Apl <br />