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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16 -6859 <br />LOCAL STREET SLURRY SEAL 2015 -16 <br />STATEMENT REGARDING "ANTI- KiCKBAC:K" REOtJI REMENTS <br />The undersigned is submitting this proposal for performing by contract the work required by <br />these bid documents, agrees to comply with the Copeland "Anti - Kickback" Act (18 USC 74) as <br />supplemented in the Department of Labor regulations (29 CFR, Part 3), This act provides that <br />each contractor or subcontractor shall be prohibited from inducing, by any means, any person <br />employed in the construction or repair of public work, to give up any part of the compensation to <br />which he/she is otherwise entitled. <br />Signed: <br />Title: <br />Firm: 7rTtpc.sx / { /li7I� ✓FJGS �NNO i 0970I✓, G G <br />Date: <br />P -15 ofP -16 <br />23A -25 <br />