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K. PROPOSAL FORM: STATEMENT OF PAST CONTRACT DISQUALIFICATIONS
The proposer shall state whether it or any of its officers or employees who have a proprietary interest in
it, has ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal,
state, or local government project because of the violation of law, a safety regulation, or for any other
reason, including but not limited to financial difficulties, project delays, or disputes regarding work or
product quality, and if so to explain the circumstances.
◼ Do you have any disqualification as described in the above paragraph to declare?
Yes No
◼ If yes, explain the circumstances.
Executed on at _______________________________________ under penalty of
perjury of the laws of the State of California, that the foregoing is true and correct.
______________________________________
Signature of Authorized Proposer Representative
6/10/2026 Columbus, OH
Docusign Envelope ID: 2A837BCA-4695-867F-83BC-82D3BF6D1F33