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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 />Vido L. Samarzich being duly sworn, deposes and says: <br />❑ 1Ni]1VIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP ']hat he/she is a mernber of the co-parhrership 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 />6CORPORATION That he is of <br />Vido Sarnarzirh, Inc- <br />a wrporation which is making the lbrcgoing proposal: <br />❑JOINT VENTURE That he is of <br />one orthe parties making the rbrcgoing prop usal as z Joint venture. and the he/she has been and is duly vested <br />with the authority to execute instruments For an on behalfof the parties making 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 hfin seIfor any other <br />person. <br />Signature of CONTRACTOR <br />Subscribed and sworn to before me this day of <br />Signature of officer Administering Oath (Notary Public} <br />20 <br />Page 3 of 10 <br />