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CITY OF SANTA SNA <br />PROPOSAL <br />PROJECT NO.: 14-7513 <br />PACIFIC ELECTRIC PARD <br />NQN-Q(' Ia US10N AFFIDAVIT <br />(Title 23 United States Code Section 112 and <br />Public Contract Code Section 7106) <br />In accordance with Title 23 United'States Code Section 112 and Public Contract Code 7106 the <br />BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed <br />person, partnership, company, association, organization, or corporation; that the -bid is genuine <br />and not collusive or sham,; that the BIDDER has not directly or indirectly induced or: solicited <br />any other BIDDER to put in a false or sham bid., and has not directly or indirectly colluded, <br />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 MDER has not in any manner, directly or indirectly, <br />sought by agreement, communication, or conference with anyone to fix the bid price of the <br />BIDDER. or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of <br />that of any other BIDDER., or to swuro any advantage against the public body awarding the <br />contract of anyone interested in the proposed contract; that all statements contained in the bid are <br />true, and, further, that the B'MDER has not, directly or indirectly, submitted his or her bid price <br />or any breakdown thereof, or the contents thereof, or divulged infoi7nation or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partner§hip, company association, <br />organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham <br />bid. <br />Mote: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal <br />on the signature portion thereof s4411 also coatstitute signature of this Non-coflusion <br />Affidavit. BIDDEare ca ed that making a false certification may subject the <br />certifier to cri irwl roseouti / <br />Signed <br />State of California <br />County of <br />St4bscribe€1 and sworn to (or affirmed) before me on this 1A -V1day of J)EC,, 20L�,, by <br />MA-vL_ Pn&2�imm, proved to me on the basis of satisfactory evidence to be the <br />person(] wha appeared before me <br />HAYLEY A, ZAYR L <br />1O OTA PUBLIC M OAi�l.f6MIA 4 <br />$ <br />0GiWSSION 0 00980;47 LP <br />08ANOC COUNTY <br />(LA rj my Camra, Exp, M9rch 4, 201€1 <br />N taffy P kic,i nature N®ryucice <br />2I 2t <br />