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CITY OF SANTA ANA <br />PROJECT 13 -7516: MADISON PARK COMMUNITY GARDEN AND BASKETBALL COURT <br />PROJECT 10 -7564: GARFIELD STREET AT BROWN STREET PARKING LOT EXTENSION <br />PROJECT 13 -7512: MABURY PARK SECURITY LIGHTING <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, Slats. 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 offenses 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 of the California State <br />University. The term 'BIDDER" is understood to include any partner, member, officer, director, <br />responsible managing officer, or responsible managing employee thereof, as referred 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 false cerdificalion may subject the certifier to criminal prosecution. <br />Signed <br />Title <br />Firm <br />Date 3,(r " <br />TO BE INCLUDED IN BID PACKAGE <br />BP 31 of 33 <br />