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Oakland Street Lighting Conversion Project - Navigator

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APPENDIX BAttachment 4Contractor’s Claim Submittal FormSection 3-7*****Under penalty of law for perjury or falsification and with specific reference to theCalifornia False Claims Act, Government Code Section 12650 et. Seq., theundersigned,Name Title Companyhereby certifies that the claim for additional compensation or time, if any, madeherein for the work on this contract is a true statement of the actual costs incurredand time sought, and is fully documented and supported under the contractbetween the parties.Dated/s/Subscribed and sworn before me this _____ day of _________________, 200__.Notary PublicMy Commission Expires*****<strong>Oakland</strong> <strong>Street</strong> <strong>Lighting</strong> <strong>Conversion</strong> <strong>Project</strong><strong>Project</strong> Special Provisions D-45 Bid Documents: Feb 2012 Update

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