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Name of Bidder: Phone: Address: Email: CERTIFICATION I certify the following on my own behalf or on behalf of the entity named above, which I am authorized to represent: A. I am a person or entity that is applying for a contract with the City of Los Angeles. B. The contract for which I am applying is an agreement for one of the following: 1. The performance of work or service to the City or the public; 2. The provision of goods, equipment, materials, or supplies; 3. Receipt of a grant of Cit.

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