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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 24-6054 <br />FIRE STATION 71 ABOVE GROUND FUEL STORAGE TANK REPLACEMENT <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Richard Camacho , being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making 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 <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />[$CORPORATION 'That he is of: <br />GEMS Environmental Management Services, Inc. <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 <br />and is duly vested with the authority to execute instruments for an on behalf of the parties <br />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 <br />to secure any advantage against the City of Santa Ana or any person interested in the proposed <br />cont rac or him r a ther per <br />SEE ATTACHED NOTARIAL. CERTIFICATE <br />Si nature o Bidder <br />Subscribed and sworn to before me this day of <br />Signature of officer Administering Oath (Notary Public) <br />20 <br />P-6 of P- 18 <br />