DISQUALIFICATION_DISCLOSURE_(4).pdf

The document is a Disqualification Disclosure form required by California Public Contract Code (PCC) §10162, specifically associated with a Nurse Educator and Continuous Quality Improvement (CQI) Program Coordinator contract opportunity for a local government agency. The form requires prospective bidders to disclose whether the bidder, any officer, or employee with proprietary interest has ever been disqualified, removed, or prevented from bidding on or completing a federal, state, or local government project due to a violation of law or safety regulation.

The disclosure form provides a simple yes/no questionnaire where bidders must indicate their compliance history under penalty of perjury. If the answer is "yes", the bidder is required to explain the circumstances and attach supporting documentation to the exhibit. This form appears to be a standard pre-qualification document designed to ensure transparency and verify the bidding entity's past performance and regulatory compliance before being considered for the Paramedic Continuing Education and CQI Program Coordinator contract.