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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 18-6918 <br />MAIN ST & 15TH ST TRAFFIC SIGNAL INSTALLATION <br />FEDERAL PROJECT NO: HSIPL 5063 (189) <br />department or agency writ Wddl this IM116=101 originated <br />may PMUO avo/oblo rowdies. Including suspension and/or <br />Cebament. <br />Cxafimlim Rog Fund Ing Debarment, Sir Wmaim, <br />Insllglbll Ry and Voluntary EMS usim.{oww Ti W <br />ParllcheMs: <br />1. The plospoclNe laver Out participant Writing, by <br />subMssbn of this proposal, that Wflba I nor its pdnclpnls Is <br />prosonlly dobamad, suspended, propertied for dobam W 1, <br />declared InotiObIc Or vohNadly excluded tram parttlps ind in <br />covered transactions by tiny Federal dopaMunl a ogamy. <br />2. Where lllo cgvo Iowa( ga pa ant is unobk to <br />catty In arty d her slnlum W Is In this W dliWdm Wch <br />p(ospeCUP0 participant dial allach an explanation to INS <br />proposal. <br />XL CERTIFICATION REGARDING USE OF CONTRACT <br />FUNDS FORLOBBy1NO <br />This provision is breakable to all Fidli construction <br />contracts and to nl rented w it animas which exceed <br />3100,000 (49 CFR 20), <br />t. The PIOapemlye perldirmt coddles, by all and <br />submfiling Orts bid IN proposal, In tha bast of Ns or her <br />hnu%fadga nod bola, that <br />a. No Fadmit approprnlm fulls have bean paid awll be <br />Paid, by Or an bphWfof the undoolaned. to ary parson to <br />hmrenclng OF atlanpting Ioinfluonce an officer of mopbyV a of <br />arty Fodarl o0omy, aMomba of Congress. an officer or <br />mrphyco of Cmgross, or an employee of a Nnmbor of <br />Congress in connection wan 0o avodbg of my Federal <br />contract, the me" army FoderaigrM, memeidng of any <br />Federal Icon, the ontorhg Into of my cooperative agroanon,. <br />and ma extension, continuation renwi amananmt a <br />modax:ation of any Fodoral contract, grant, loan u( <br />ccopemtivo agmomoH. <br />IF I any fmns oma hao Federal eppmpriatedfunds hme <br />bran pant a wi' be paid to anypersm fa laluermd� a <br />attompbnq to hguunco an officer a ompkyoo oiary Fodoml <br />FAUsray, a Mother of Cangross, on officer aarnpbym of <br />Congress, or an employs of a Weber of Cmgmss in <br />mnnocifon With mls Federal contact, grant, am, a <br />ceopemOve agroommt. the andaraignod slnl complete an <br />stbma Stallard Form LLL, "Dbaosm, Femm to Repro <br />LobbybV, In naordarcn with Its lnstrocgWs. <br />T. Thb codlkulkn ls a molalol mM"Illoilm olfaciupon <br />watch ralance was &Cod w/rW Oils Imnsaclim was made a <br />ordmidinto. SubnisslonotmiscodBkalbnhopromgdsgo <br />t"Fer"q a entering trio this transaction hmposod by 31 <br />U.S, C. 135Z Any prim 40 fails In file lie requi id <br />Wdlkalon Final be subject toFir d4 pmWty Inot Yale Iron <br />$10.000 and not rtore than SiMpoo fo each such failure. <br />3. The pmMmctlw padkpml also agrees by aubmsting ga <br />Ud of PMPMI that the ponklpant sing Fact like that the <br />IMIOM o of this certification be Ionhdod In all bwor Ua <br />subcoatracls, which oxwed $100,000 am that all such <br />(aclphrts shnl Godly and disclose accordhtjy. <br />P-29 of P-52 <br />