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CA <br />SANTA <br />PROJECT• <br />. 16-6467 <br />PROPOSAL <br />(ADDENDUM ONE — JULY 22, 2016) <br />E UBLIC!C{)N'rilikC l C4`rLiIT I:C'rJON 101(x''21 Q :STIQ3NNAIR <br />In conformance with Public Contract Code Section 10162, the BIDDER shall <br />complete,under penalty of perjury,h A following questionnaire: <br />Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDE=R who has <br />a proprietary interest In the BIDDER, ever been disqualified, removed, or otherwise <br />prevented from bidding on, or completing a federal, state, or local government project <br />because of a violation of Eaw or a safety regulation" <br />Yes No <br />If the answer is yes, explain the circumstances in the following space. <br />Giryr of Saf tti Afia t Projerl 16,6467 SiRrrtf d e� 'r `I �Of Y# i D viogsim Projeo I REDO) {:dobcr 7. 2016 <br />