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23B - PROJ - ROADWAY REHAB
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06/16/2015
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23B - PROJ - ROADWAY REHAB
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Last modified
6/11/2015 3:48:41 PM
Creation date
6/11/2015 3:30:35 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
6/16/2015
Destruction Year
2020
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CITY OF SANTA ANA <br />PROPOSAL <br />Project No. 14 -6801: McFadden Avenue from Newhope Street to Harbor Boulevard <br />Project No. 14 -6804: Civic Center Drive from Main to Spurgeon Street <br />Project No. 14 -6811: Memory Lane from Main Street to North City Limit <br />OWNERSHIP AFFIDAVIT <br />STATE Of CALIFORNIA <br />I <br />COUNTY OF ORANGE <br />I SS: <br />CITY OF SANTA ANA <br />) <br />wnr m aamne: <br />, being duly sworn, deposes and says: <br />❑ INDIVIDUAL <br />That he /she is the party making the foregoing proposal: <br />❑ PARTNERS14JP <br />That he /she is a member of the copartnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the copartnership by: <br />who constitute the other members of the copartnership, <br />❑* CORPORATION <br />That he is of: <br />eaye anninnefmy and oevempmen. Inc <br />a corporation which is making the foregoing proposal: <br />[-]JOINT VENTURE <br />That lie is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he /she has <br />been and is duty vested with the authority to execute instruments for an on behalf of the <br />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 <br />colt lion to secure any advantage against the City of Santa Ana or any person interested in the <br />pro osed contract, for h' 's"�lf or any other person. <br />Signature of Bidder <br />sworn to before me this i day of J 20 <br />Oath (Notary Public) <br />J�OV�ANA 5i� TEFL HENS" <br />Commission # 1955860 a <br />$ • uu Notary public • California <br />a <br />San Bernardino County <br />FA Gomm. Ez fires Oct 8 2015' <br />BP -7 <br />23B -21 <br />
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