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CITY OF SANTA ANA <br />PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST <br />PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST <br />PROPOSAL AND CONTRACT AGREEMENT <br />PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT <br />In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER hereby <br />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 offenses referred to in that section, including any charge of fraud, <br />bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection <br />with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract <br />Code Section 1 101, with any public entity, as defined in Public Contract Code Section 1 100, including the <br />Regents of the University of California or the Trustees of the California State University. The term <br />"BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, or <br />responsible managing employee thereof, as referred to in Section 10285.1. <br />Note: The BIDDER must place a check mark after "has" or "has not" in one of the blank spaces provided. <br />The above Statement is part of the Proposal. Signing this Proposal on t e signature portion thereof <br />shall also constitute signature of this Statement. BIDDERS are cautio d that making a false <br />certification may subject the certifid? t rcrc? i3p,inal prosecution. ? <br />Signed <br />Title ?FJr <br />Firm <br />Date S?Z??1Z <br />TO BE INCLUDED IN BID PACKAGE <br />BP 30 of 32