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CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15 -6834 TRAFFIC SIGNAL MODIFICATIONS: 17""' STREET AT ENGLISH STREET, MACARTIIUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE AT SULLIVAN STREET, WESTMINSTER AVENUE AT CLINTON STREET FEDERAL PROJECT NO: HSIPL. 5063(156) PUBLIC CON "IRACT CODE SEC ONN 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _, has not 4been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1 101, with any public entity, as defined in Public Contract Code Section 1 100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof', as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement, Bidders are cautioned that making a false certification may subject the certifier too criminal prosecrution. Signed Title President Firm California Professional Engineering Inc. Date 05/04/2016 P -21 of P -40 20D -36