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CITY OF SANTA ANA <br />PROJECT NOS. 12- 6777 AND 12-6775 <br />PROPOSAL AN:D CONTRACT AGREEMENT <br />PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT <br />In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under <br />penalty of perjury, the following questionnaire. <br />Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a <br />proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from <br />bidding on, or completing a federal, state, or local government project because of a violation of law <br />or a safety regulation? <br />Yes No X <br />If the answer is yes, explain the circumstances in the following space. <br />TO BE IIVCLIJDED IN BID PACKAGE <br />BP 15 of 15