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CITY OF SANTA ANA <br />• PROPOSAL AND CONTRACT AGREEMENT <br />PROPOSAL NO. 10-7504 <br />TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 <br />DEBARMENT AND SUSPENSION CERTIFICATION <br />The BIDDER under penalty of perjury, certifies that except as noted below, he/she or any <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 ineligibility <br />by any federal agency; <br />has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency <br />within past three years; <br />has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent <br />jurisdiction in any matter involving fraud or official misconduct within the past 3 years. <br />If there are any exceptions to this certification, insert the exceptions in the following space. <br />• N J /~ <br />Exceptions will not necessarily result in denial of award, but will be considered in determining <br />BIDDERS responsibility. For any exception noted above, indicate below to whom it applies, initialing <br />agency, and dates of action. <br />Note: Providing false information may result in criminal prosecution or administrative sanctions. <br />The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall <br />also constitute signature of this Certification. <br />Name of BIDDER ~i<1~I~R {~~1VIN-C-~ CD., (RIC_ <br />Signature of BIDDER c-E ~'® <br />Date ~. Z10.1 ~ <br />FED.8-22-88 <br />TO BE INCLUDED IN BID PACKAGE <br />BP 19 of 31 <br />