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Appendix -------- -
<br />ATTACHA/lITPIT 3-1: NON -COLLUSION ,A-PTDAVIT
<br />CERTIFICATIONS
<br />CONSTRUCTAT ILl'I'V REVIEW
<br />NON -COLLUSION AFFIDAVIT
<br />(Title 23 United States Code Section 1 12, and
<br />Public Contract Code Section 7106)
<br />To Ilse CITY OP SANTA ANA DEPARTNM ENT OF PUBLIC WORKS
<br />In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares
<br />thal the bid is not made in the interest of, or on behalfof, any undisclosed Person, partnership, company, association,
<br />organization, or corporation; that file bid is genuine and not collusive or sham; that the BIDDER has not directly or
<br />Indirectly induced or selieitecl any other BIDDER to put in a false or sham bid, and has not directly or indirectly
<br />colluded, conspired, connived or agreed with any 131DDER or anyone else to put in a sham bid, or that anyone shall
<br />refi'ain Prom bidding; that file BIDDER has not in any manner, directly or indirectly, sought by agreement,
<br />communication, Or conference with anyone to fix file bid price of file BIDDER or any BIDDER, or to Fix any
<br />overhead, profit, or cost element orthe bid price, o or that of any other BIDDER, or to secure any advantage against
<br />lite public body awarding the contract ol'anyone interested In file proposed contract; That all statements contained in
<br />the bid are true; cod, turlhe, that tho BIDDER has not, directly or indirectly, submitted his or her bid price or any
<br />breakdown Ihereof,, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay,
<br />any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent
<br />thereof to CN ctuate it collusive or sham bid.
<br />Note: 'Phe above Non collusion Affidavit is part of the Proposal. Signing this Proposal on the signature
<br />portion thereof shall als� cordlite signature ol'this NoncollusionAI'ficlavit. BIDDERS are cautioned that
<br />makinW4 tidse cerliticali,�n roily sub,jecl tj1e certilicr to criminal prosecution.
<br />/ r7
<br />Signed
<br />State ol'Caliti9Pnia
<br />County of r;�:a„� G.
<br />Subscribed and sworn to for affirmed) before me on this� clay of Judy_. 20L by
<br />proved to me on the basis OF satislactoty evidence to be the persoo�) who appealed
<br />befoe mc.
<br />NOt y Pt nekf ignature Notary Public Seal
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<br />Yy y , OANIEL J. TCHOnLYK 6
<br />�;zi ,1 NOCO/kit
<br />t COMMISSION AG2007477 NIA
<br />d hi+' �'' UnhNG[COUNTY t,
<br />,i � h1y COrOm. Exp. January 17, 2.010 (,
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<br />City of Banta Ana RFP
<br />Pago A3-1
<br />
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