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EXHIBIT E -4 <br />ANTI - KICKBACK STATEMENT <br />CITY OF EUGENE <br />CAPITAL IMPROVEMENT PROGRAM <br />TO: City of Eugene Capital Improvement Program <br />RE: Project <br />DATE: 07/07/10 <br />The undersigned contractor certifies that: <br />1. The total contract price is for only those items listed on the Work Write -Up, and none other; <br />2. There has not been, and will not be, any kickbacks, credit or other similar payment in any <br />form made to the owner or any other person; <br />CONTRACTOR <br />CONTRACTOR SIGNATU <br />& Print <br />ATTEST: <br />Sign & print name <br />Sign & print name <br />Prime Contractor to complete <br />