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EXHIBIT E <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR MEDICAL SERVICES REVIEW PROGRAM <br />PROPOSER'S STATEMENT <br />Proposer understands and agrees that this written RFP (or any part thereof specifically designated and accepted by <br />the City of Santa Ana, hereinafter City) shall constitute the entire agreement between Proposer and the City only <br />after it!has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official <br />seal noting hereon the action of approval of the Council, signed by the Executive Director or his duly authorized <br />agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and <br />when it or an exact copy of it has been either delivered to Proposer or deposited with the United States Postal <br />Service properly addressed to the Proposer with the correct postage affixed thereto. <br />Proposer further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish City all <br />required bonds and certificate of liability insurance within ten (10) days (excluding Saturdays, Sundays and City's <br />legal holidays), or the funds, check, draft, or Proposer's bond substituted in lieu thereof accompanying this proposal <br />shall become the property of the City and shall be considered as payment of damages due to the delay and other <br />causes suffered by City because of the failure to furnish the necessary bonds and because it is distinctly agreed <br />that the proof of damages actually suffered by City is difficult to ascertain; otherwise said funds, check drafts, or <br />Proposer's bond substituted in lieu thereof shall be returned to the undersigned. <br />Proposer understands that a proposal is required for the entire work, that the estimated quantities set forth in the <br />RFP schedule are solely for the purpose of comparing proposals, and that final compensation under the contract <br />will be based upon the actual quantities of work satisfactorily completed. <br />All terms contained in the specifications, the certification of nondiscrimination by contractors, and the required <br />insurance certificates are to be incorporated by reference into this agreement and are made specifically as part of <br />this RFP. <br />Firm <br />Signed and Printed Name: <br />Title <br />Date <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City of Santa Ana Human Resources Department <br />RFP for Medical Services Review — August 27, 2018 <br />2612-E '18 <br />