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BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.5 and in conformance with Public Contract
Code Section 10162, the Bidder shall complete, under penalty of perjury, the following
questionnaire:
QUESTIONNAIRE
Has the Bidder, any officer, principal or employee of the Bidder who has a proprietary interest in
the business of the Bidder, ever been disqualified, removed, or otherwise prevented from bidding
on or completing a federal, state or local government project because of violation of law or a
safety regulation?
YES NO
If the answer is yes, explain the circumstances in the following space:
STATEMENT
In conformance with Public Contract Code Section 10232, the Contractor, hereby states under
penalty of perjury, that no more than on final unappealable finding of contempt of court by a
federal court has been issued against the Contractor within the immediately preceding two-year
period because of the Contractor’s failure to comply with an order of a federal court which orders
the Contractor to comply with an order of the National Labor Relations Board.
NOTE: The above Statement and Questionnaire are part of the Proposal. Signing
this Proposal on the signature portion thereof shall also constitute signature
of this Statement and Questionnaire.
Bidders are cautioned that making a false certification may subject the
certifier to criminal prosecution.
X
SEAN PAYAN dba BLUE COLLAR CONTRACTORS