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ii <br /> CITY OF SANTA ANA <br /> • PROPOSAL AND CONTRACT AGREEMENT <br /> Project No. 04-7711 Elder Avenue Improvements: Sullivan to Center <br /> Project No. 04-7712 La Verne Avenue Improvements: Sullivan to Center&Center Storm Drain <br /> Project No. 04-7713 Borchard Avenue Improvements: Sullivan to Center <br /> TITLE 49, CODE OF FEDERAL REGULATIONS,PART 29 <br /> DEBARMENT AND SUSPENSION CERTIFICATION <br /> The bidder under penalty of perjury, certifies that except as noted below, he/she or any person <br /> associated therewith in the capacity of owner,partner, director, officer,manager: <br /> is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility <br /> by any federal agency; <br /> has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency <br /> within past three years; <br /> has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent <br /> jurisdiction in any matter involving fraud or official misconduct within the past 3 years. <br /> If there are any exceptions to this certification, insert the exceptions in the following space. <br /> Exceptions will not necessarily result in denial of award, but will be considered in determining <br /> bidders responsibility. For any exception noted above,indicate below to whom it applies,initialing agency, <br /> and dates of action. <br /> Note: Providing false information may result in criminal prosecution or administrative sanctions. <br /> The above certification is part of the Proposal, Signing this Proposal on the signature portion thereof shall <br /> also constitute signature of this Certification. <br /> Name of Bidder K cap,s fru e 'io„ <br /> Signature of Bidd aria <br /> Date ,5///cr-G <br /> FED.8-22-88 <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP 19 of 28 <br />