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FULL PACKET_2016-05-03
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FULL PACKET_2016-05-03
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5/23/2019 2:16:17 PM
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City Clerk
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Agenda Packet
Agency
Clerk of the Council
Date
5/3/2016
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Appendix <br />ATTACHMENT 3-1: NON -COLLUSION AFFIDAVIT <br />CI:IRTIFICATIONS <br />GEO'I'ECNNICAL, SPECIAL INSPECTION, & MATE RIAL TGSI•INC: <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />-1 it the CITY OF SANrA ANA DEPARTMUNFol. PUB1,W WORKS <br />In accordance with 'I ille 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid <br />is not made in the interest ol', or cat behalf, of, any n1tdiSel0Sed person, ptu'tncrship, company, association, organization, or <br />corporation; that the bid is genuine and riot collusive or shaur that the BIDDER has not directly or indirectly induced or <br />solicited tiny other BIDDER to put in a False or sham bid, and has not directly or indirectly colluded, conspired, connived or <br />agreed with any BIDDER or anyone else to put in a sham bid, or that attyonc shall refrain liom bidding; That the BIDDER has <br />not in any manner. directly or indirectly, sought by agreement, conummicadon, or conference Nvith anyone to Iix the bid price <br />of the BIDDER or any BIDUGR, or to tix any overhead, prolit, or cost element of the hid price, or or that of any other <br />BIDUGR, or to secure any advantage against the public body awarding the contract or anyone interested in the proposed <br />conh,act; that all statements contained in the bid are true: and. further, that the BIDDER has not, directly or indirectly, <br />submitted his or her bid price or any breakdown thereof, or file contents thereof: or divulged information or data relative <br />thareto, or paid, and will not pny, any I'ce to any corporation, partnership, company association, organization, bid depository, <br />or to any member oragcnt thereoFlo erIbMulte a collusive or sham bid, <br />El <br />F <br />L <br />Now: The above Non -collusion Affidavit is part of the Propostd. Signing this Proposal on die signauur portion <br />thereof shill) also constitute signature or this Non -collusion Affidavit, BIDDLRS are cautioned that snaking a false <br />acrlilivafion may subject the ccrtii tSleriminal prosecution. <br />Signed /� ) <br />State ol,Celilinnitt <br />County of OPnaae <br />Subscribed and sworn to (or al'I- il''�ted) beFore me on this day olFebruary 2O 1 lby <br />proved to too on the basis oi'satisfa tory evidence to be the persons) who appeared bc1bre mc. <br />M <br />Notary Public Signature Notary Public Scal <br />AESCO P4882, City of Santa Ali@ RFP No. 15-055 Gectechnical, Special inspection & Material Testing fo �] <br />Public Works Agency Capitol Improvement <br />City of Santa Ana RFP 15.055 <br />Pagca AV <br />25N-30 <br />
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