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• CITY OF SANTA ANA • PROJECT NO. 08-5017: TRAFFIC SIGNAL INSTALLATION ON WILLITS ST & SULLIVAN ST PROJECT NO. 08-5021: TRAFFIC SIGNAL INSTALLATION ON RAITT ST & GLENWOOD AVE PROJECT NO. 08-5022: TRAFFIC SIGNAL INSTALLATION ON HARBOR BLVD & KENT AVE PROJECT NO. 08-5023: TRAFFIC SIGNAL MODIFICATION ON SANTA ANA BL & FLOWER ST PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _ ,has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bids are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed Title ~1 U N ~otjJ C-hA-N , GE° Firm LINCOLN PACIFIC BUILDERS, INC Date 02•Zti-~ l v TO BE INCLUDED IN BID PACKAGE BP 32 of 34