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Local Assistance Procedures Manual EXHIBIT 12-E <br />PS&E Checklist Instructions Attachment D <br />ATTACHMENT D NONCOLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 slid <br />Public Contract Code Section 7106) <br />To the CITY / COUNTY of <br />DEPARTMENT OF PUBLIC WORKS. <br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares <br />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 has not <br />directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or <br />indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that <br />anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by <br />agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to <br />fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage <br />against the public body awarding the contract of anyone interested in the proposed contract; that all statements <br />contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid <br />price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, <br />and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to <br />any member or agent thereof to effectuate a collusive or sham bid. <br />Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature <br />portion thereof shall also constitute signature of this Noncollusion Affidavit. <br />Bidders are cautioned that making a false certification may subject the certifier to criminal <br />prosecution. <br />Page 12-29 <br />OB 12-04 June 29, 2012 <br />