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7.1.C. - Page 35 <br /> Exhibit "G" <br /> Certification of Consultant, Commissions & Fees <br /> (Caltrans Form 10-F) <br /> I HEREBY CERTIFY that I am the Vice President , and duly autharized <br /> representative of the firm of Bellecci&Associates , whose address is <br /> 6601 Koll Center Parkway,S#e.240•Pleasanton,CA 94566 , and that,except as hereby <br /> expressly stated,neither I nor the above firm that I represent have: <br /> (a) employed or retained far a commission, percentage,brokerage, contingent fee, ar other consideration, <br /> any firm or person(other than a bona fide employee working solely for me or the above consultant)to <br /> solicit or secure this contract; nor <br /> (b) agreed,as an express ar implied condition far obtaining this contract,to employ ar retain the services <br /> of any firm ar person in connection with carrying out the contract; nar <br /> (c) paid, or agreed to pay,to any firm, arganization or person(other than a bona fide employee working <br /> solely for me or the above consultant)any fee, contribution, donation, or consideration of any kind,for or <br /> in connection with, procuring or carrying out this contract. <br /> I acl�owledge that this Certificate is to be made a�ailable to the California Department of Transportation <br /> (Caltrans)in connection with this contract involving participation of federal-aid highway funds, and is subject to <br /> applicable state and federal laws,both criminal and civil. <br /> 9116/13 <br /> (Date) (S ignature) <br /> Distribution: 1) Local Agency Project File(Origi�al&Contract) <br /> 2) DLAE(with contract copy) <br /> Page 1 of 1 <br /> LPP 13-01 May 8,2013 <br /> REV:09-26-13 VR <br /> Page 33 of 38 <br />