Common use of NON-COLLUSION AFFIDAVIT Clause in Contracts

NON-COLLUSION AFFIDAVIT. STATE OF , COUNTY OF , , being first duly sworn, deposes and says that he is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; that such bid is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder had not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one else to put in a sham bid, or that any one shall refrain from bidding; that said bidder has not in any manner, directly or indirectly, sought by agreement, communication or conference with any one to fix the bid price of said bidder or of any other bidder, or to fix any overhead, profit or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one interested in the proposed contract; that all statements contained in such bid are true; and, further, that said bidder had not, directly or indirectly, submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in his general business. SIGNED: (Title) Subscribed and sworn to before me this day of , 2010. Seal of Notary Notary Public SIGNATURE AND IDENTITY OF BIDDER The undersigned states that the correct LEGAL NAME and ADDRESS of (1) the individual Bidder, (2) each partner or joint venture (whether individuals or corporations, and whether doing business under a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws of state of . Dated , 20 . Name of individual, all partners, or joint venture Address of each: Doing business under the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name of the individual, partners, or corporation, with the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, as required by the Standard Specification, Section 102.6.6 and 102.6.7.

NON-COLLUSION AFFIDAVIT. Note: To be executed by Proposer and submitted with proposal. STATE OF , COUNTY OF , CALIFORNIA County of , being first duly sworn, sworn deposes and says that he he/she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; bid that such bid is not made in the interest of or on the behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, bid and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said bidder has not in any manner, manner directly or indirectly, indirectly sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said bidder or of any other bidder, bidder or to fix any overheadoverhead profit, profit or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such bid are true; and, and further, that said bidder had not, has not directly or indirectly, indirectly submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith therewith, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such any person or persons as have a partnership or other financial interest with said bidder in his the general business. SIGNED: (Title) By Subscribed and sworn to before me this day of , 2010. Seal of Notary 20 Notary Public SIGNATURE AND IDENTITY in and for said County and State Appendix IV – References Using the format below, provide five (5) customer references that are similar in size and project scope to the City. Three of the five references must include agencies with public safety classifications. Client Reference Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference EXHIBIT B Proposal / Scope of Services Response to: City of Anaheim Attn: Xxxxxx Xxxx and Xxxx Xxxxx For: Request for Proposal Medical Evaluation Services October 2022 Submitted by: Xxxxxx Permanente Xxxxxx Permanente On-the-Job® Xxxx Xxxxxx, ARM Account Manager IV 0000 X. Xxxxx Xx., Xxx. 0000 Xxxxx Xxx, XX 00000 Mobile (000) 000-0000 xxxx.x.xxxxxx@xx.xxx TABLE OF BIDDER The undersigned states that CONTENTS Letter of Transmittal Executive Summary Experience Firm Background Personnel Work Plan Reporting References Contract Performance Scope of Services Fee Schedule Business License Certificate of Insurance General Conditions CV and Resume KPOJ Southern California Map Non‐Collusion Affidavit LETTER OF TRANSMITTAL October 7, 2022 City of Anaheim Human Resources Department Anaheim West Tower, 5th Floor 000 Xxxxx Xxxxxxx Xxxxxxxxx Xxxxxxx, XX 00000 Attn: Xxxxxx Xxxx and Xxxx Xxxxx RE: RFP for Medical Evaluation Services On behalf of Xxxxxx Permanente, I appreciate the correct LEGAL NAME opportunity to respond to the City of Anaheim’s Request for Proposal for Medical Evaluation Services. This response will remain valid for a period of not less than ninety (90) days from the date of submittal and ADDRESS should be considered a demonstration of (1) our desire to work with the individual BidderCity of Anaheim and our commitment to helping you reduce costs, (2) each partner or joint venture (whether individuals or corporationsmitigate health and safety risks, and whether doing business under boost employee performance with high quality, cost-effective occupational health and safety services that: • Educate employees about on-the-job safety and wellness • Identify health and safety issues before they cause problems • Improve employee health and reduce absenteeism and presenteeism • Support regulatory compliance • Increase employee satisfaction As one of California’s largest providers of occupational health and safety services, with 24 clinics throughout Southern California and three clinics within the Orange County Service Area, we are experts in keeping employees safe and healthy on the job. Sincerely, Xxxx Xxxxxx Xxxx Xxxxxx, ARM Account Manager IV Xxxxxx Permanente On-the-Job® 0000 X. Xxxxx Xx., Xxx. 0000 Xxxxx Xxx, XX 00000 M: (000) 000-0000 xxxx.x.xxxxxx@xx.xxx EXECUTIVE SUMMARY Xxxxxx Permanente appreciates the opportunity to respond to the City of Anaheim’s request for proposal for occupational health services. Xxxxxx Permanente is uniquely positioned as a fictitious nametotally integrated healthcare system. As such, or (3) using our electronic health record, HealthConnect™ and with proper HIPAA releases, our physicians can access a majority of your employees’ relevant medical information, allowing our physicians to potentially identify conditions that could negatively impact your employees’/applicants’ ability to safely perform their jobs. Proper and early identification leads to lower health care costs for the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention City of binding himself to become the responsible and sole contractor) he is the agent ofAnaheim, and duly authorized potentially minimizes your Workers’ Compensation risks and costs, while leading to improved health and productivity of your workforce. Approximately 52% of the City of Anaheim employees have chosen Xxxxxx Permanente as their health plan. Xxxxxx Permanente On-the-Job® can help the City of Anaheim reduce costs, mitigate health and safety risks, and boost employee performance with a comprehensive occupational health and safety services program. We are experts in writing to sign for keeping employees safe and healthy on the Bidder or Biddersjob, and that he expertise is signing demonstrated in our: HIGH-QUALITY CARE • We promote consistent standards and executing this (as indicted best practices in the proper spaces below) as the proposal of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws of state of occupational health and safety throughout our integrated system. Dated , 20 . Name of individual, all partners, or joint venture Address of each: Doing business under the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition • Our highly skilled physicians are dedicated to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name occupational health services and have an in-depth understanding of the individualcomplexities of workforce regulations. • Our extensive peer reviews and continuing medical education requirements ensure physician and staff quality remains high. • We train, partners, or corporation, with the legal address showncertify, and REGISTRATION OF FICTITIOUS NAME filed monitor all our technicians for regulatory compliance and testing accuracy. FOCUS ON PREVENTION • We work with you to maximize employee participation and identify potential health or safety problems before they result in reduced productivity or worksite injury. • Our electronic health information system, Xxxxxx Permanente HealthConnect™, enables us to trend data over time and identify developing work-related health issues, such as hearing or lung function loss, so that employees can take preventive measures before the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, as required by the Standard Specification, Section 102.6.6 and 102.6.7problem becomes serious.

NON-COLLUSION AFFIDAVIT. STATE OF , COUNTY OF , ss. County of Los Angeles) , being first duly sworn, deposes and says that he or she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; , that such the bid is not made in the interest of of, or on behalf of of, any undisclosed person, partnership, company, association, organization organization, or corporation; that such the bid is genuine and not collusive or sham; that said the bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said the bidder has not in any manner, directly or indirectly, sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said the bidder or of any other bidder, or to fix any overhead, profit profit, or cost element of such the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such the bid are true; and, further, that said the bidder had has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid paid, and will not pay pay, any fee in connection therewith to any corporation, partnership, company, company association, organization, bid depository, or to any member or agent thereof, thereof to effectuate a collusive or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in his general business. SIGNED: (Title) sham bid.” Signature of Bidder Business Address Place of Residence‌ Subscribed and sworn to before me this day of , 201020 . Seal of Notary Notary Public SIGNATURE AND IDENTITY OF BIDDER The undersigned states that the correct LEGAL NAME in and ADDRESS of (1) the individual Bidder, (2) each partner or joint venture (whether individuals or corporations, and whether doing business under a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal County of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws State of state of California. Dated My Commission Expires , 20 . Name Professional Services Agreement Providing for Payment of individualPrevailing Wages City of Calabasas//Venco Western, all partners, or joint venture Address of each: Doing business under Inc. WORKERS’ COMPENSATION INSURANCE CERTIFICATE The Contractor shall execute the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name of the individual, partners, or corporation, with the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, form as required by the Standard SpecificationCalifornia Labor Code, Sections 1860 and 1861: I am aware of the provisions of Section 102.6.6 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and 102.6.7.I will comply with such provisions before commencing the performance of the work of this contract. DATE: By: (Contractor) (Signature) (Title) Attest: By: (Signature) (Title)

NON-COLLUSION AFFIDAVIT. ‌ Note: To be executed by Proposer and submitted with proposal. STATE OF , COUNTY OF , CALIFORNIA County of , being first duly sworn, sworn deposes and says that he he/she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; bid that such bid is not made in the interest of or on the behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, bid and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said bidder has not in any manner, manner directly or indirectly, indirectly sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said bidder or of any other bidder, bidder or to fix any overheadoverhead profit, profit or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such bid are true; and, and further, that said bidder had not, has not directly or indirectly, indirectly submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith therewith, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such any person or persons as have a partnership or other financial interest with said bidder in his the general business. SIGNED: (Title) By Subscribed and sworn to before me this day of , 2010. Seal of Notary 20 Notary Public SIGNATURE AND IDENTITY in and for said County and State Appendix IV: References‌ Client Reference No. 1 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 2 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 3 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 4 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 5 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference EXHIBIT B PSYCHOLOGIST'S PROPOSAL PSYCHOLOGICAL SERVICES PROPOSAL CITY OF BIDDER ANAHEIM XXXXX XXXX-XXXXXXXX, PH.D., ABPP A PROFESSIONAL CORPORATION 00000 XXXXXXX XXXXXXXXX, XXXXX 000 XXXXXX, XXXXXXXXXX 00000 TELEPHONE (000) 000-0000 FAX (000) 000-0000 TABLE OF CONTENTS Page Executive Summary 1 Experience ………………………………….…………………………. 3 Firm Background 4 Personnel 4 Reporting ……………………………………………………………... 5 Contracting Performance …………………………………………….. 5 RFP Exceptions ………………………………………………………. 5 Attachments: Curriculum Vitae – Xxxxx Xxxx-Xxxxxxxx, Ph.D., ABPP Sample Pre-Employment Psychological Evaluation Report Authorization note from Xxxxx Xxxx-Xxxxxxxx, Ph.D., ABPP Non-Collusion Affidavit – Appendix III Client References – Appendix IV XXXXX XXXX-XXXXXXXX, PH.D., ABPP, APC LICENSED PSYCHOLOGIST 00000 XXXXXXX XXXXXXXXX, XXXXX 000 XXXXXX, XXXXXXXXXX 00000-0000 xxx.xxxxxxxxxxx.xxx TELEPHONE (000) 000-0000 License #PSY4923 January 4, 2017 RE: Request for Proposal for Psychological Services for the City of Anaheim Dear Evaluation Committee, I have had the honor of working with public safety agencies in Southern California since the inception of police psychology. Starting “in house”, I was involved in starting and serving on the SWAT team and initiating the first mandatory psychological intervention after traumatic incidents. As a private contractor, I have worked with State and local agencies to develop tools and procedures for psychological evaluation that set standards nationwide. The undersigned states that methods used are fiscally responsible with no adverse impact. There have been no legal actions related to my services. Over the correct LEGAL NAME and ADDRESS years I have stayed on top of (1) all professional developments. I was instrumental in developing the individual Bidderfield of police psychology, (2) each partner or joint venture (whether individuals or corporationsincluding 1031F of the Government Code, and whether doing business under most recently establishing specialty status and certification (ABPP). I served on the founding executive committee of the American Board of Police and Public Safety Psychology from 2011 to 2016. The committee set the standard requirements for certification and examined prospective specialists. I consulted on the original 1984 POST Pre Employment Psychological Screening Guidelines and on laws related to psychological services. As a fictitious nameconsultant to POST, or (3) I worked on the corporation (recent guidelines revision chairing the section on interview protocol. I taught seminars with POST to train psychologists across the state in which it is incorporated) are shown below; State. Currently, I serve on a POST committee that (if not signing crafted requirements for psychologists to conduct pre-employment screening. We approve acceptable course work. My consultation with POST has included input on the intention of binding himself to become the responsible and sole contractor) he is the agent ofBackground Investigation Guidelines, State regulations, and duly authorized in writing issues of reinstatement and reserve peace officers. Because POST does not govern firefighters I worked with fire departments to sign adapt guidelines to their needs. EXPERIENCE: Xxxxx Xxxx-Xxxxxxxx, Ph.D., ABPP, APC is organized for the Bidder or Bidderssole purpose of providing psychological services to public safety agencies. No other clients are served and all clients are in Southern California so that service can be provided on short notice as needed. We can schedule appointments within 10 days and on shorter notice when needed. All systems, procedures, and that he work settings were designed for the needs of public safety psychological services. We recently moved to a purpose designed office with extra security for records and with space for test administration in large groups or individually for greater privacy. We have room to test 30 applicants at a time plus a training room, conference room and seven interview rooms. A site visit would be very welcome. State-of-the-art computer and test scanning equipment is signing purchased specifically for the needs of public safety test scoring and executing this (staff is selected and trained for the ability to perform high quality service. Sample testing materials are available on request. Each professional member of the staff is highly experienced and qualified in police psychology and pre-employment screening of peace officers, and each could testify as indicted an expert witness in the proper spaces below) field. All staff members have passed a background check. Xx. Xxxx-Xxxxxxxx helped establish police psychology as a specialty and initiated programs now implemented all over the proposal of country. She performs and oversees a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws of state of . Dated , 20 . Name of individual, all partners, or joint venture Address of each: Doing business under highly qualified staff who provide the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed services requested in the legal name of the individualRFP. Last year we provided psychological services including pre-employment psychological evaluations, partners, or corporation, with the legal address shownfitness for duty evaluations, and REGISTRATION OF FICTITIOUS NAME filed critical incident debriefings and post traumatic interventions for approximately (100) public safety agencies. Overall, we have provided well over 100,000 evaluations including 2,000 Fitness for Duty Evaluations. In addition, management consultation and training has been provided on an as needed-basis. All staff has extensive experience in psychology including direct experience in psychological screening. Curriculum Vitae is attached for Xxxxx Xxxx-Xxxxxxxx, Ph.D., ABPP. Vitas for all staff can be provided on request. We have knowledge of all applicable laws and recent court decisions relating to law enforcement pre-employment/special psychological evaluations. This includes the Americans with the Secretary Disabilities Act, Genetic Information Non Discrimination Act, Equal Employment Opportunity rules and regulations, and HIPPA. Knowledge comes from professional journals and newsletters, continuing education, conferences and discussions with other psychologists and attorneys. References will show adherence to all timelines. Client list is available on request. Additional staff will be hired and trained as needed. FIRM BACKGROUND:‌ Company Legal Name: Xxxxx Xxxx-Xxxxxxxx, Ph.D., ABPP, A Professional Corporation Company Legal Status : Corporation – 100% Ownership Year of StateIncorporation: 1986 The corporation has been providing public safety psychological counseling, as required by Sections 417.200 pre-employment evaluations, fitness for duty evaluations, training and consultation from 1976 to 417.230 X.X.Xxpresent PERSONNEL: Four licensed psychologists – all comply with POST requirements. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, as required by the Standard Specification, Section 102.6.6 and 102.6.7All staff have passed background checks.

NON-COLLUSION AFFIDAVIT. STATE OF , COUNTY OF , ss. County of Los Angeles) , being first duly sworn, deposes and says that he or she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; , that such the bid is not made in the interest of of, or on behalf of of, any undisclosed person, partnership, company, association, organization organization, or corporation; that such the bid is genuine and not collusive or sham; that said the bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said the bidder has not in any manner, directly or indirectly, sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said the bidder or of any other bidder, or to fix any overhead, profit profit, or cost element of such the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such the bid are true; and, further, that said the bidder had has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid paid, and will not pay pay, any fee in connection therewith to any corporation, partnership, company, company association, organization, bid depository, or to any member or agent thereof, thereof to effectuate a collusive or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in his general business. SIGNED: (Title) sham bid.” Signature of Bidder Business Address Place of Residence Subscribed and sworn to before me this day of , 201020 . Seal of Notary Notary Public SIGNATURE AND IDENTITY OF BIDDER The undersigned states that the correct LEGAL NAME in and ADDRESS of (1) the individual Bidder, (2) each partner or joint venture (whether individuals or corporations, and whether doing business under a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal County of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws State of state of California. Dated My Commission Expires , 20 . Name of individual, all partners, or joint venture Address of each: Doing business under WORKERS’ COMPENSATION INSURANCE CERTIFICATE The Contractor shall execute the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name of the individual, partners, or corporation, with the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, form as required by the Standard SpecificationCalifornia Labor Code, Sections 1860 and 1861: I am aware of the provisions of Section 102.6.6 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and 102.6.7.I will comply with such provisions before commencing the performance of the work of this contract. DATE: By: (Contractor) (Signature) (Title) Attest: By: (Signature)

NON-COLLUSION AFFIDAVIT. ‌ Note: To be executed by Proposer and submitted with proposal. STATE OF , COUNTY OF , CALIFORNIA County of , being first duly sworn, sworn deposes and says that he he/she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; bid that such bid is not made in the interest of or on the behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, bid and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said bidder has not in any manner, manner directly or indirectly, indirectly sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said bidder or of any other bidder, bidder or to fix any overheadoverhead profit, profit or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such bid are true; and, and further, that said bidder had not, has not directly or indirectly, indirectly submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith therewith, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such any person or persons as have a partnership or other financial interest with said bidder in his the general business. SIGNED: (Title) By Subscribed and sworn to before me this day of , 2010. Seal of Notary 20 Notary Public SIGNATURE AND IDENTITY OF BIDDER The undersigned states that the correct LEGAL NAME in and ADDRESS of (1) the individual Bidderfor said County and State Appendix IV: References‌ Client Reference No. 1 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 2 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 3 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 4 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference Client Reference No. 5 Item Vendor Response Name Project Description Contact Name Contact Telephone Number Contact E-mail Address Business Initiation Date Business End Date Rationale for Inclusion as a Reference EXHIBIT B PSYCHOLOGIST'S PROPOSAL ‌ SPI Psychological Services Prepared For In Reference to 309-HR-12/16/2016 for Pre-Employment Psychological Evaluations Pricing SPI-Xxxxxxx Psychological Institute 000 Xxxxx Xxxxxx Xxx Xxxxx, (2) each partner or joint venture (whether individuals or corporations, and whether doing business under a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws of state of . Dated , 20 . Name of individual, all partners, or joint venture Address of eachCA 90731 SECTION 6: Doing business under the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name of the individual, partners, or corporation, with the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, as required by the Standard Specification, Section 102.6.6 and 102.6.7.FEE PROPOSAL Year 1 Year 2 Year 3 $450.00 per person $468.00 per person $480.00 per person

NON-COLLUSION AFFIDAVIT. Note: To be executed by Proposer and submitted with proposal. STATE OF , COUNTY OF , CALIFORNIA County of , being first duly sworn, sworn deposes and says that he he/she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; bid that such bid is not made in the interest of or on the behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, bid and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said bidder has not in any manner, manner directly or indirectly, indirectly sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said bidder or of any other bidder, bidder or to fix any overheadoverhead profit, profit or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such bid are true; and, and further, that said bidder had not, has not directly or indirectly, indirectly submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith therewith, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such any person or persons as have a partnership or other financial interest with said bidder in his the general business. SIGNED: (Title) Signed Subscribed and sworn to before me this day of , 2010. Seal of Notary 20 Notary Public SIGNATURE AND IDENTITY OF BIDDER in and for said County and State Appendix IV: References Client Reference No. 1 Item Vendor Response Agency Name Contact Name Contact Telephone Number Contact E-mail Address Approximate Agency Size Approximate Number of Assessments Conducted Business Initiation Date Rationale for Inclusion as a Reference Client Reference No. 2 Item Vendor Response Agency Name Contact Name Contact Telephone Number Contact E-mail Address Approximate Agency Size Approximate Number of Assessments Conducted Business Initiation Date Rationale for Inclusion as a Reference Client Reference No. 3 Item Vendor Response Agency Name Contact Name Contact Telephone Number Contact E-mail Address Approximate Agency Size Business Initiation Date Approximate Number of Assessments Conducted Rationale for Inclusion as a Reference Client Reference No. 4 Item Vendor Response Agency Name Contact Name Contact Telephone Number Contact E-mail Address Approximate Agency Size Business Initiation Date Approximate Number of Assessments Conducted Rationale for Inclusion as a Reference Client Reference No. 5 Item Vendor Response Agency Name Contact Name Contact Telephone Number Contact E-mail Address Approximate Agency Size Business Initiation Date Approximate Number of Assessments Conducted Rationale for Inclusion as a Reference EXHIBIT B Proposal / Scope of Services ALTA Language Services, Inc. Tel: 000-000-0000 Fax: 000-000-0000 xxx.xxxxxxxx.xxx Request for Proposal for The undersigned states that the correct LEGAL NAME City of Anaheim Prepared and ADDRESS of (1) the individual Biddersubmitted by ALTA Language Services, (2) each partner or joint venture (whether individuals or corporationsInc. 0000 Xxxxx Xxxx XX, and whether doing business under Xxxxx 000 Atlanta, Georgia 30326 000-000-0000 Main 000-000-0000 Fax xxx.xxxxxxxx.xxx ALTA Language Services, Inc. Tel: 000-000-0000 Fax: 000-000-0000 xxx.xxxxxxxx.xxx This document is a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws of state of . Dated , 20 . Name of individual, all partners, or joint venture Address of each: Doing business under the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name part of the individualquotation of ALTA Language Services, partners, or corporation, with Inc. (ALTA) to provide language proficiency testing services to the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary City of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, as required by the Standard Specification, Section 102.6.6 and 102.6.7Anaheim.

NON-COLLUSION AFFIDAVIT. STATE OF , COUNTY OF , ss. County of Los Angeles) , being first duly sworn, deposes and says that he or she is * (sole owner, partner, president, secretary, etc.) of , the party making the foregoing bid; , that such the bid is not made in the interest of of, or on behalf of of, any undisclosed person, partnership, company, association, organization organization, or corporation; that such the bid is genuine and not collusive or sham; that said the bidder had has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or any one anyone else to put in a sham bid, or that any one anyone shall refrain from bidding; that said the bidder has not in any manner, directly or indirectly, sought by agreement, communication communication, or conference with any one anyone to fix the bid price of said the bidder or of any other bidder, or to fix any overhead, profit profit, or cost element of such the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or any one of anyone interested in the proposed contract; that all statements contained in such the bid are true; and, further, that said the bidder had has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid paid, and will not pay pay, any fee in connection therewith to any corporation, partnership, company, company association, organization, bid depository, or to any member or agent thereof, thereof to effectuate a collusive or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in his general business. SIGNED: (Title) sham bid.” Signature of Bidder Business Address Place of Residence‌ Subscribed and sworn to before me this day of , 201020 . Seal of Notary Notary Public SIGNATURE AND IDENTITY OF BIDDER The undersigned states that the correct LEGAL NAME in and ADDRESS of (1) the individual Bidder, (2) each partner or joint venture (whether individuals or corporations, and whether doing business under a fictitious name, or (3) the corporation (with the state in which it is incorporated) are shown below; that (if not signing with the intention of binding himself to become the responsible and sole contractor) he is the agent of, and duly authorized in writing to sign for the Bidder or Bidders, and that he is signing and executing this (as indicted in the proper spaces below) as the proposal County of a ( ) sole individual ( ) partnership ( ) joint venture ( ) corporation, incorporated under laws State of state of California. Dated My Commission Expires , 20 . Name Professional Services Agreement Providing for Payment of individualPrevailing Wages City of Calabasas//Venco Western, all partners, or joint venture Address of each: Doing business under Inc. WORKERS’ COMPENSATION INSURANCE CERTIFICATE The Contractor shall execute the name of Address of principal place of business in Missouri (if using a fictitious name, show this name above in addition to legal name) (If a corporation, show its name above.) ATTEST: (SEAL) Secretary Title (NOTE: If the Bidder is doing business under a FICTITIOUS NAME, the Proposal shall be executed in the legal name of the individual, partners, or corporation, with the legal address shown, and REGISTRATION OF FICTITIOUS NAME filed with the Secretary of State, as required by Sections 417.200 to 417.230 X.X.Xx. IF the Bidder is a CORPORATION NOT ORGANIZED UNDER THE LAWS OF MISSOURI, it shall procure a CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI, as required by Section 351.570 and following X.X.Xx. A CERTIFIED COPY of such Registration of Fictitious Name or Certificate of Authority to do business in Missouri shall be filed with the Missouri Highway and Transportation Commission, form as required by the Standard SpecificationCalifornia Labor Code, Sections 1860 and 1861: I am aware of the provisions of Section 102.6.6 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and 102.6.7.I will comply with such provisions before commencing the performance of the work of this contract. DATE: By: (Contractor) (Signature) (Title) Attest: By: (Signature) (Title) PROFESSIONAL SERVICES AGREEMENT Providing for Payment of Prevailing Wages (City of Calabasas/ Venco Western, Inc.)