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CITY OF SANTA ANA <br />PROPOSAL Add No. One <br />PROJECT NO.: 18-2681 <br />CENTENNIAL LAKE CIRCULATION RENOVATION <br />DEBARMENT AND SUSPENSION CERTIFICATION <br />TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 <br />The BIDDER, under penalty of perjury, certifies that, except as noted below, he/she or any other <br />person associated therewith in the capacity of owner, partner, director, officer, manager: <br />• is not currently under suspension, debarment, voluntary exclusion, or determination of <br />ineligibility by any Federal agency; <br />• has not been suspended, debarred, voluntarily excluded or determined ineligible by any <br />Federal agency within the past 3 years; <br />• does not have a proposed debarment pending; and <br />• has not been indicted, convicted, or had a civil judgment rendered against it by a court of <br />competent jurisdiction in any matter involving fraud or official misconduct within the past <br />3 years. <br />If there are any exceptions to this certification, insert the exceptions in the following space. <br />Exceptions will not necessarily result in denial of award, but will be considered in determining <br />bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating <br />agency, and dates of action. <br />Signature: <br />Printed Name: Daniel Duarte <br />Title: President <br />Firm Name: CJW Construction, Inc. <br />Note: Providing false information may result in criminal prosecution or administrative <br />sanctions. <br />P-22 of P-25 <br />