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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6834 <br />TRAFFIC SIGNAL MODIFICATIONS: 171 u STREET AT ENGLISH STREET, <br />MACARTHUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE <br />AT SULLIVAN STREET. WESTMINSTER AVENUE AT CLINTON STREET <br />FEDERAL PROJECT NO: NSIPL 5063(156) <br />OWNERSHIP AFFIDAVIT <br />STAT}, OF CALIFORNIA <br />COUN-IY OF ORANGE. <br />(.I 1 Y OF SANTA ANA <br />Van Nguyen <br />❑ INDIVIDUAL <br />❑ PARTNERSHIP <br />SS: <br />being duly sworn. deposes and says: <br />That he/she is the parry making the foregoing proposal: <br />I hat he/she is n member ol'the co-partnet ship firm designated as: <br />and who has been and is duly vested with the authority to make and e.xccate instruments for the co- <br />partnership by: <br />who constitute the other members ol'the co -partnership. <br />® CORPORATION That he is e : president of California Professional Engneering, Inc. <br />a corporation tchich is making the foregoing proposal: ---- <br />❑ JOIN I' VFNTURF lYiat he is ol't <br />one ol'the parties making Tire foregoing proposal as a joint eenhina, and the he/she has been and is duly <br />vested with the anthorlq- to execute instruments for an oil behalf ot'the parties making said bid who are: <br />that such a bid is genuine and�ot collusive or shaft, and has not in any manner sought by collusion to <br />secw•e any ac vantage against tl e City of Santa Ana or any person interested in the proposed contract, for <br />himself oRan o n.0 <br />Signature of <br />Subscribed and sworn to beforeiue this �i` day of 20 ILP <br />Signature of officer Administering Oath (Notary Public) <br />MA <br />P-8 of P-40 <br />20D-14 <br />