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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6834 <br />TRAFFIC SIGNAL MODIFICATIONS: 17' 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: HSIPL 5063(156) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Van Nguyen <br />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 make and execute instruments for the co- <br />partnership by: <br />who constitute the other members of the co -partnership. <br />® CORPORATION That he is of <br />President of California Professional Engineering Inc. <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That lie is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is duly <br />vested with the authority to execute instruments for an on behalf of the parties making said bid who are: <br />that such a bid is genuine andot collusive or sham, and has not in any manner sought by collusion to <br />secure any a vantage against t e City of Santa Ana or any person interested in the proposed contract, for <br />himself or. an o <br />Signature <br />Subscribed and sworn to before -le this Hday of 20(LQ <br />Signature of officer Administering Oath (Notary Public) <br />P-8 of P-40 <br />