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EXHIBIT K <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR <br />SECURE BIKE PARKING FACILITIES <br />Installatlon and S®tvlce Apree ant <br />RFP #13 -019 <br />PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT <br />In conformance with Public Contract Code Section 10285A (Chapter 376, Stats. 1985), the BIDDER hereby <br />declares under penalty of perjury under the laws of the State of California that the BIDDER has _ , has not <br />been convicted within the preceding three years of any offenses referred to in that section, including any <br />charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law <br />in 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 1100, <br />including the Regents of the University of California or the Trustees of the California State University. The <br />term "BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, <br />or responsible managing employee thereof, as referred to in Section 10285.1. <br />Note: The BIDDER must place a check mark a8er "has" or "has not" in one of the blank spaces provided. The <br />above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also <br />mnstitoteslimature of this Statement, BIDDERS are cautioned that making a false certification may <br />Signed tC <br />Title C <br />Firm <br />Date �7 <br />THIS FORM MUST BE COMPLETED AND INCLUDED MITHTHE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />nsmme�+r <br />-'- - " <br />City of Santa Ana RFP 13-019 <br />Page 30 <br />25A -53 <br />