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Nnme: <br /> <br />D.O.B: <br /> <br />Social Security No: <br /> <br />Residence Address: <br /> <br />A certification that the contractor has fully complied with all applicable <br />federal and state reporting requirements regarding its employees; and <br /> <br />A certification that the contractor has fully complied with all lawfully served <br />Wage and Earnings Assignment Orders and Notices of Assignment and Will <br />continue to so comply, <br /> <br /> tl,e City of <br />"I certify that Santa Aha is in full compliance with all applicable federal and <br /> <br />state reporting requirements regarding its employees and with all lawfully served Wage <br />and Earnings Assignment Orders and Notices of Assignments and will continue to be in <br />compliance throughout the term of any contract issued pursuant to this Request for <br />Proposal process with the County of Orange. I understand that failure to comply shall <br />constitute a material breach of the contract and that failure to cure such breach within 60 <br />calendar days of notice from the County shall consfftute grounds for termination of the <br />con tract.' <br /> <br />David N. Ream, City Manager <br /> <br />Authorized Signature Name Title <br /> <br /> <br />