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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />C" p' RR®LWN , 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 matte 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 />PREWENT MEL PAVING CMVAW <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of: <br />one of the parties malting the foregoing proposal as a joint venture, and the he/she has <br />been and is duly 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 />collusion to secure any advantage against the City of Santa Ana or any person interested in the <br />proposed contract, for himself or any other person. <br />`T. flx�� G --p- Oi , PRESIDENT <br />Signature of Bidder <br />Subscribed and sWo1A to before me this A`7R 1 12016. day of <br />Signature o o ficer A inistering Oath (Notary Public) <br />C. PHILLIPS <br />W ;, COMM. #t1996177 m <br />Notary m <br />Y Pn blit, California q <br />LOS ANGfw'LES COUNTY a <br />My 00MIM. NOWOct. 29, 201® <br />P-6 of P-18 <br />20 <br />