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l XH1BIT 12 (cont.) <br />4. Fffitrts made to assist W/MRF in obtaining honding, lines of credir or insurance, and arty rechnical assi,etnnec <br />related ro the plan~, specifications and rcgkiirements for I.he work which was providcd to W/M llk: <br />None <br />5. Any additional data to support a dcnl0nst1-ati011 of good faith effort, such as contracts with WIMBE assistance <br />ageucies: <br />I declare under penalty o%petleuv that Ihe./btzgoing iorJrtrtnatton it true and cortzxt to the best olirrrp ILnowledge. I <br />nndercvntd that the Cin, )/ Sta?to A;m nndl w the C' .S- "T"rflnent of Hneising and Urban Mn"'Iftjrment neat verih, <br />the information provided herein in connection with 11 /MGE compliance evahlationlandit activities and that failure <br />to Jitlly and OfthfidlI' cutup/etc this fbi IN nary reUdt in CV00I00niC or other Sanction.;. <br />M4_,nature: <br />Name: <br />Geo .. y <br />Title: <br />Date: <br />A ,,l 27, 2021 <br />Name of Contractor/Subcontractor: <br />Servitek Electric, Inc. <br />Contractor/Subcontractor Identification <br />Number; <br />1035350, C-10 <br />Address (Street, City, State, Zip): <br />385 S Lemon Ave. #243, Walnut, CA 91789 <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the racial/ethnic/gender character of the owners) and controller(s) of SI",, <br />of the business. When 51u, or more is not owned and controlled by any s ingle racial/ethnicity/gender category, <br />Cirdc the Code which seems nlest appropriate. <br />1 = White Amcticuts <br />? — Rlac'.k Americans <br />3 Native Americans <br />Woman Owned Business: <br />Circle One: <br />4 =His auic Atncriams <br />5 — Asuat. Pacrttc: Amen ianS <br />6 Hasidic 7etirs <br />Council <br />r zocsiFROPSVcs, ittDrowswD.t500MMD-SecGon3Spea DOC <br />11 — 54 <br />5/18/2021 <br />