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(9) City of Santa Ana <br />ITEM 14: CONFLICT OF INTEREST CERTIFICATION <br />The undersigned hereby certifies on behalf of ("Proposer"), and hereby <br />declares under penalty of perjury under the laws of the State of California, that Proposer is not, and will <br />not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a <br />contract and if authorized to perform the services described in this RFP. <br />Signed, this day of , 2012 in , California. <br />IF SOLE OWNER: <br />Signature of Owner Date <br />Print Name <br />IF PARTNERSHIP UPA or merge <br />Signature of Partner (General Partner) Date <br />Print Name <br />IF CORPORATION: <br />Signature of President Date <br />Print Name <br />Signature of Secretary Date <br />Print Name <br />Phase 2 RFP: Emergency Ambulance Transportation and Related Services Page 72 <br />June 14, 2012 <br />25F-91