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Section 3 Resident Cerlificotion Employee Residing in Los Angeles County Submif with Bid if Box I is checked on Secfion 3 Buslness Certificafion or for New Hires NAME ADDRESS I hereby certify thot I om o Section 3 residenl; bosed on fhe following quolificotion(s): l, n I om o Public Housing Resident: NAlvlE OF PUBLIC HOUSING SllE ADDRESS OF PUBLIC HOUSING SIÏE 2,n I om o low-income resident of the metropoliton oreo ond: 20IT INCOME LIMITS My household Size is: My household's gross onnuol income from oll sources is: n l S50,500 or less u 2 S57.700 or less tr $ó4,900 or less ! 4 $722,100 or less ! Ã $77,900 or less u 6 S83,ó50 or less u 7 S89,450 or less u 8 $95,200 or less According fo Title 18, Secfion 1001 of fhe U.S, Code, it is o felony for ony person fo knowingly ond willingly moke folse or froudulent sfafements fo ony deportmenf of fhe Unifed Sfofes Government, l, fhe undersigned, hereby cerfify fhof oll sfotemenfs contoined herein, ore frue ond correcf to the best of my knowledge ond belief. I undersfond fhe informofion I provide in fhis cerfificofion is subject fo verificotion, ond I ogree to provide necessory documentofion if requesfed. Under the penolty of perjury, I cedify thot the obove informolion is true ond corecf. EMPLOYEE SIGNATURE To be Completed by Employer: DATE The obove-nomed person wos hired previous to this certificotion on: The obove-nomed person is o new hire os of: The obove-nomed person's job title is: Compony Nome: Employer Nome/Signoture ---PAGE BREAK--- Section 3 Residenl Certificotion Employee Residing in Kern County Submit wifh Bid if Box I is checked on Secfion 3 Buslness Certificofion or for New Hires NAME ADDRESS I hereby cerlify thqt I om o Seclion 3 resident; bosed on the following quolificolion(s): l. n I om o Public Housing Resident: NAIVIE OF PUBLIC HOUSING SIÌE ADDRESS OF PUBLIC HOUSING SITE I om o low-income resident of the metropoliton oreo ond: 20IT INCOME LIMITS My household Size is: My household's gross onnuol income from oll sources is: n 1 $50,500 or less n 2 $57,700 or less n 3 5ó4,900 or less n 4 5722,1OO or less n 5 $77,900 or less n 6 $83,ó50 or less n 7 $89,450 or less n I 595,200 or less According fo Tifle 18, Secfion l00l of fhe U.S. Code, if is o felony for ony person fo knowingly ond willingly moke folse or froudulent sfofements to ony deportmenf of the Unifed Stofes Government, I, fhe undersigned, hereby certify fhot oll stofements contoined herein, ore true ond correct fo fhe besf of my knowledge ond belief. I understond the informotion I provide in fhis certificotion is subjecf fo verificofion, ond I ogree to provide necessory documentotion if requesfed. Under the penolty of perjury, I cerlify thot lhe obove informotion is true qnd corecl. EMPLOYEE SIGNATURE To be Completed by Employer: DAIE The obove-nomed person wos hired previous to this certificotion on: The obove-nomed person is o new hire os of: The above-nomed person's job title is: Compony Nome; Employer Nome/Signoture: ---PAGE BREAK--- Section 3 Residenl Certificqtion Employee Residing in Son Bernordino County / Riverside County Submif wifh Bid if Box I is checked on Secfion 3 Busrness Certificotion or for New Hires NAlvlE ADDRESS I hereby certify thot I om o Section 3 resident; bosed on the following quolificotion(s): L n lom o Public Housing Resident: NAME OF PUBLIC HOUSING SITE ADDRESS OF PUBLIC HOUSING SITE 2 u I om o low-income resident of the metropoliton oreo ond: 20'I7 INCOME LIMITS My household Size is: My household's gross onnuql income from oll sources is: $50,500 or less n 2 $57,700 or less n 3 $ó4,900 or less u 4 $722,100 or less n 5 577,9OO or less n $83,ó50 or less ! 7 $89,450 or less ! B $95,200 or less According fo Title lB, Section l00l of the U,S, Code, it is o felony for ony person to knowingly ond willingly moke folse or froudulent sfotemenfs fo ony deportment of fhe United Sfofes Governmenf, l, the undersigned, hereby ceiify fhof oll stotemenfs confoined herein, ore true ond correct to fhe best of my knowledge ond belief. I understond the informofion I provide in fhis certificofion is subject to verificofion, ond I ogree fo provide necessory documentofion if requested. Under the penolty of perjury, I cedify thot lhe qbove informotion is true ond corecl EMPLOYEE SIGNATURE DATE ïo be Compleled by Employer: The obove-nomed person wos hired previous to this certificotion on: The obove-nomed person is o new hire os of: The obove-nomed person's job title is: Compony Nome: Employer Nome/Signoture: