DISQUALIFICATION_DISCLOSURE_(4).pdf

This is a Disqualification Disclosure form required by the City of Pasadena for the Design-Build Services for a Hydrogen Fueling Station project, pursuant to California Public Contract Code Section 10162. The form requires prospective bidders to disclose under penalty of perjury whether the bidder, any officer of the bidder, or any employee with a proprietary interest has ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state, or local government project due to violation of law or safety regulations. Bidders must indicate yes or no to this inquiry and, if applicable, provide a detailed explanation of circumstances with supporting documentation attached as an exhibit to the response.

This disqualification disclosure is a mandatory pre-submission requirement for all proposers interested in the hydrogen fueling station design-build-operate-maintain contract. Completion of this form is a compliance obligation separate from technical and price proposal submissions, and failure to accurately and truthfully complete this disclosure could result in proposal rejection or disqualification from consideration. The form serves as a preliminary qualification screening mechanism to ensure that only vendors with satisfactory legal and regulatory compliance histories are permitted to proceed in the competitive best-value selection process.