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CITY OF SANTA ANA <br />RFP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all his/her <br />subcontractors are registered with the State of California Department of Industrial Relations (DIR), and that the <br />following is hue and correct. <br />Contractor's Name: PALP, INC DBA EXCEL PAVING <br />i <br />Business Address: LONG BEACH, CA <br />Business E-Mail Address:`'°°'Oat <br />Telephone: 562) 599-5$41 <br />State Contractor's License No. and Class: STATE LIG# 688659 <br />A. 31 <br />License Expiration Date: 2,0 Z�a -- <br />State Dept. of Industrial Relations (DIR) DIR# 1000003331 <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) - <br />Registration Expiration Date: 1p 3d 12025 <br />Signed: <br />Title: <br />urtis P. Brown III President <br />Page 1 of 10 <br />