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CITY OF SANTA ANA <br />-- PROJECT NO. 11-7509 CITYWIDE RESIDENTIAL STREET REPAIR -PHASE 15 <br />PROPOSAL AND CONTRACT AGREEMENT <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 person <br />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\?_ <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 crim;nal 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 ?l-}- <br />Signature ofBIDDER (tp <br />Date ?lo-,?a?t '1?,? YiceQ?re5ida?rl- <br />FED.8-22-88 <br />TO BE INCZUDED IN BID PACKAGE <br />BP 20 of 29