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CITY OF SANTA ANA <br />REQUEST Pon PROPOSALS FOR JANITORIAL SERVICES <br />. --00t LUMQUAF-,n& <br />Mtn CJt.LUSIC?N AFt"1P: AVIT <br />(Title ?S United States Code Section 11.2 and <br />Public Contract Code Section 7106) <br />To the CITY OF SANTA ANA., <br />In azccordancs with Title 23 €JnHod States Code Section 112 and Public Contract Cade 7,f06 the proposer <br />declares that the proposal is not Made In the interest of, Or on behalf of, any undisclosed person, <br />partnership, company, association, organization, or corporation; that the proposal Is genuine cnld not <br />collusive Or sharrr, that the proposer has riot directly or Indirectly induced or solicited any othve proposer <br />to put to a false or sham proposal, and has not directly or indirectly colluded, conspired, connived or <br />agreed with any proposer or anyone else to put In a sham proposal, or that anyone shall refrain from <br />bidding; that the proposer has not In any MOM, directly or indlreetky, sought by agreement, <br />communication, or conterence with anyone to IN the proposal price of the proposer or any proposer, or to <br />fix any overhead, profit, or cost element .or the proposal price, or of that of warty other proposer, or to <br />secure any advrrn*,age against tiro public body awarding the contract of anyone interested in that <br />proposed contract; that all statements contained to the proposal are true; and, further, that the proposer <br />has not, d5recti+y or tni submitted his or her proposal price Or any breakdown thereof, or the <br />contents thereof, or divulged information or data MIMIwe 11i or paid, and wilt not pay, any tee to any <br />corporation, partnershIp, company association, organization, bid depository,, of to any member or atglerst <br />thereat to effectuate a collusive or hem proposal, <br />Nate; The above non -collusion affidavit is part at lira submitted proposal, Signing Oils proposal on the <br />signature i. rtl'an thereof shall also constitute signature of this ncn•collusiori affidavit. Proposers are <br />oauttonod that making a false certification may subject flip ceriitter to crinalnatt prosecution. <br />�Signet�F Irineo Nuno — Printed Name <br />State of California, County ot_San Bernardino <br />Subscribed and sviicrn to (or arttirrrredJ before me on this ,day of�, ICJ by <br />Ravin i proved to me an the basis of satisfactory evidowice to be the <br />persrsn(s,j who appeared before me, <br />Notary Public ,Signentura Notary Public Seat <br />THIS FORM trAtJa�T 8 tiMt� � t �t7 ANC3 CLU C) WITH THE PROP <br />T PROPOSALS THAT pO NOT CONTAIN THIS FORM WILL RE CONId RER No <br />ra+kga 44 <br />FCC Jantroriat S orvf�wa R4 P t7-022 <br />