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OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY SOF SANTA ANA &,4r 54 AY i , being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the parry making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments for the co- <br />partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of. P fP I i d e n I <br />❑ JOINT VENTURE That he is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is <br />duly vested with the authority to execute instruments for an on behalf of the parties making said bid <br />who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to <br />secure any advantage aga. t the City of Santa Ana or any person interested in the proposed contract, for <br />himself or any other pe n. <br />Signature ON CTOR <br />Subscribed and wom to before me this � ` day of 64ab- 20 -*-a <br />Signature of o car Administering Oath ji otary Pub ) <br />N Muc- 8Y R <br />CoYY.a 2184302 <br />0 OMME "N <br />�.�' Yr Cast E>m. Yita. t2, IOQt" <br />Cj�y� nt�SP 20-106 <br />