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CITY OF SANTA ANA <br />RFP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Curtis P. Brown III <br />being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party malting 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 partnership <br />by: <br />who constitute the other members of the co partnership. <br />CORPORATION That he is of PRESIDENT PALP, INC DBA <br />Y <br />a corporation which is making the foregoing proposal: <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 duly vested <br />with the authority to execute instruments for an on behalf of the parties malting said bid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any <br />advantage against the City of Santa Ana or any person interested in the proposed contract, for himself or any other <br />person. <br />o Curtis P. Brown II! <br />Sig ure of CONTRACTOR President <br />Subscribed and sworn to before me this VFA a VIV of <br />Signature of officer Administing Oath (Notary Public) <br />R- [:C7vtNG701V 1i <br />�y COMM 023:3$692 N <br />�4tjary Iryrjb1w-Cr0WMiz' 4 <br />ANUELES COUNTY <br />20 <br />Page 3 of 10 <br />