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<br />Name: <br /> <br />D.O.B: <br />Social Security No: <br />Residence Address: <br /> <br />C. A certification that the contractor has fully complied with all applicable federal and state <br />reporting requirements regarding its employees; and <br /> <br />D. A certification that the contractor has fully complied with all lawfully served Wage and <br />Earnings Assignment Orders and Notices of Assignment and will continue to so comply. <br /> <br />the City of <br />"I certifiJ that Santa Ana is in full compliance with all applicable federal and state <br />reporting requirements regarding its employees and with all lawfully served Wage and Earnings <br />Assignment Orders and Notices of Assignments and will continue to be in compliance throughout <br />the tern! of any contract issued pursuant to this Request for Proposal process with the County of <br />Orange. I understand that failure to comply shall constitute a material breach of the contract and <br />that failure to cure such breach within 60 calendar days of notice from the County shall constitute <br />grounds for temzination of the contract." <br /> <br />f1-dlaf ~ <br /> <br />, <br /> <br />David N. Ream. City Manager <br /> <br />Authorized Signature <br /> <br />Name <br /> <br />Title <br />