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TO BE INCL.UIDED IN PROPOSAL. <br />EXHIBIT G <br />CITY OF SANTA ANA COMMUNITY DEVELOPMENT <br />REQUEST FOR QUALIFICATIONS FOR ENVIRONMENTAL SERVICES <br />NON-COLLUSION AFFIDAVIT <br />CITY OF SANTA ANA <br />PROPOSAL AND CONTRACT AGREEMENT <br />NON - COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7`106) <br />To the City of SANTA ANA COMMUNITY DEVELOPMENT AGENCY <br />In accordance with Title 23 United State Code Section '112 and Public Contract Code 7166 the PROPOSER <br />declares that this bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, <br />company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the <br />PROPOSER has not directly or indirectly induced or solicited any other PROPOSER to put in a false or sham <br />bid, and has riot directly or indirectly colluded, conspired, connived or agreed with any PROPOSER or anyone <br />else to put in a sharn bid, or that anyone shall refrain from bidding; that the PROPOSER has not in any <br />manner, directly or indirectly, sought by agreement, communication or conference with anyone to fix the bid <br />price of the PROPOSER or any PROPOSER, or to fix any overhead, profit, or cost element of the bid price, or <br />of that of any other PROPOSER, or to secure any advantage against the public body awarding the contract of <br />anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that <br />the contents thereof, or divulged information or data relative thereof, or paid, and will not pay, any fee to any <br />corporation, partnership, company associations, organization, bid depository, or to any member or agent <br />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 <br />portion thereof shall also constitute signature of this Non- collusion Affidavit. PROPOSERS are <br />cautioned that making a false certification may subject the certifier to criminal prosecution. <br />State of California <br />County of Orange r <br />P(, <br />Subscribed a d sworn to (or affirmed) before me on this ��__ day of ( 20�dL, by <br />'.�...., ry _ I;,., yam• <br />'��;,,�„,�R,a;„, ,proved to me on the bards of satisfactory evidence to the person(s) <br />vvho appeared before me. <br />TEAE9ITA DC I A Cnt)Z <br />—) a y uarrnn+lsaiai7 20322,10 <br />�<''f l al,�% PBOtarpPhiUlw Culnurniu <br />f ✓ kF er r � . , Drem{IO INqu121y <br />�r �w NA uamm. Ed roe it) 017 <br />Notary Public Signature <br />City of Santa Aria Community Development Agency <br />Request for Proposals Environmental Services <br />Page 17 <br />