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CITY OF SANTA ANA <br /> PROPOSAL <br /> PROJECT NO.: 25-6030 <br /> TRAFFIC SIGNAL INSTALLATION AT SEGERSTROM AVENUE AND ROSEWOOD <br /> AVENUE <br /> CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br /> The undersigned contractor,or corporate officer, declares under penalty of perjury that he/she and <br /> all his/her subcontractors are registered with the State of California Department of Industrial <br /> Relations (DIR), and that the following is true and correct. <br /> Contractor's Name: <br /> Business Address: <br /> Business E-Mail Address: <br /> Telephone: <br /> State Contractor's License No. and Class: <br /> License Expiration Date: <br /> State Dept. of Industrial Relations (DIR) <br /> Registration No.: <br /> State Dept. of Industrial Relations (DIR) <br /> Registration Expiration Date: <br /> Signed: <br /> Title: <br /> P-5 of P-19 <br />