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City of • • Ana <br />Wr <br />ITEM 15: STATEMENT OF TRUTH <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 the information provided <br />by Proposer and contained in this bid to the (TBD) EMS 9 -1 -1 Emergency Transportation Service RFP is <br />accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the <br />information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information <br />contained herein contains material misrepresentations and /or material omissions of fact, the City of Santa <br />Ana of Santa Ana may, at its sole discretion, pursue any and all remedies available as authorized by law, <br />which may include the right, at the option of the City, to either reject or disqualify this bid proposal from <br />further consideration in the course of the procurement process and/or to declare any contract awarded as <br />the result thereof void. Signed, this day of , 2012 <br />in , California. <br />In the event that one of the above events occurs during the bid submittal date and contract award, the new <br />corporation/stockholder must provide a notarized statement stating their agreement to the terms and <br />conditions of the contract and prior to bid submittal without exceptions. This must be received within 5 <br />business days of the change <br />IF SOLE OWNER: <br />Signature of Owner <br />Date <br />Print Name <br />IF PARTNERSHIP UPA or merger): <br />Signature of Partner (General Partner) <br />Date <br />Print Name <br />IF CORPORATION: <br />Signature of President <br />Date <br />Print Name <br />Signature of Secretary <br />Date <br />Print Name <br />Phase 2 RFP: Emergency Ambulance Transportation and Related Services Page 173 <br />June 14, 2012 <br />25F -92 <br />