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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17-6611 <br />CHESTNUT AVE & BUSH/CYPRESS BIKE LANES <br />FAID#: U58DP005861 <br />NON -COLLUSION AFFIDAVIT <br />(Title 23 United States Code Section 112 and Public Contract Code Section 7106) <br />In conformance 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 BIDDER 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 other BIDDER, or to fix any overhead, profit, or cost element of the bid price, <br />or of that of any other BIDDER, or to secure 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 BIDDER has not, directly or indirectly, submitted his or her bid price <br />or any breakdown thereof, or the contents thereof, or divulged information or data relative <br />thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, <br />organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham <br />bid. <br />Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are <br />cautioned that making a false certification may subject the certifier to criminal <br />prosecution. <br />Signed <br />State of California <br />Nfluty of <br />Subscribed and ss o (or affirmed) before me on this <br />oved to me on the ais- <br />person(s) who appeared before me <br />Notary Public Signature Notary P <br />A notary public or other officer completing this certihcale verifies only the <br />Itlen11 of iM1e InEwitluai who sgne0 the Document to which this ceNhcate 19 aXacheJ. <br />entl not the truthfulness accuracy or vaLtllty of that tlocumenl <br />State of California. County of.SAnr 6,CAJA Ala? <br />Subscribed and sworn to (ar af6lrretetl) before me on this day <br />of M A k64 0l I7 by �' - CL. jy_ <br />+ - c <br />proved to me on the basis of satisfactory evidence to be the <br />person(ai who appeared before me <br />Signature (seal) <br />P-12 of P-39 <br />20, by <br />evidence to be the <br />am <br />N2ANARES2151f609 N • Csli/ornia �6np Ctwnty" war aq, aaao <br />