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CITY OF SANTA ANA <br />PROJECT NO.' 11-7508; LACY NEIGHBORHOOD SEWER AND WATER MAIN <br />IIVIPROVEMENTS <br />PROPOSAL AND CONTRACT AGREEMENT <br />PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT <br />7n conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER <br />hereby declares <br />under penalty of perjury under the laws of the State of California that the BIDDER has _ ,has not <br />been convicted <br />within the preceding three years of any otI'enses referred to in that section, including any charge of <br />fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in <br />connection with the bidding upon, award of, or performance of, any public works contract, as defined in <br />Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section <br />1100, including the Regents of the University of California or the Trustees ofthe Cglifonria State <br />University. The term "BIDDER" is understood to include any partner, member, otI'icer, director, <br />responsible managing ofl3cer, or responsible managing employee thereof, as referxiCd to in:Section ? .:.: . <br />10285.1. <br />Note: The BIDDER must place a check mark after "has^ or "has not^ in one of the blank spaces <br />provided_ The above Statement is part of the Proposal. Signing this Proposal on the signature <br />portion thereof shall also constitute signature of this Statement. BIDDERS are cautioned that <br />making a falsefication may subject the certifier to r*+*+++*+s+1 prosecution. <br />Signed <br />Title y ,?«?? <br />Firm /??/ /(mod-?.?- ??Z?? AP- ?h?-? <br />Date <br />U//e <br />TO BE INCLUDED IN BID PACKAGE <br />BP 28 of 31