DISQUALIFICATION_DISCLOSURE_(4).pdf

This is a Disqualification Disclosure form required by the City of Pasadena, California, in accordance with 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 in the bidder has ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state, or local government project due to a violation of law or safety regulation. Bidders must indicate whether their answer is yes or no and provide explanations and supporting documentation if applicable.

The disclosure form serves as a qualification screening mechanism for the Community-Police Mediation Pilot Program, which seeks an organization to provide mediation services for resolving complaints involving Pasadena Police Department personnel. Prospective bidders must complete this certification truthfully as part of their proposal submission, and any false statements made under penalty of perjury may result in legal consequences. This requirement ensures that only qualified organizations without disqualifying violations participate in the selection process.