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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6870 <br />SAFE ROUTES TO SCHOOL ENHANCEMENTS FOR HENINGER ELEMENTARY <br />STATE PROJECT NO: ATPL- 5063(159) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />COUNTY OF ORANGE <br />CITY OF SANTA ANA <br />Van Nguyen <br />❑ INDIVIDUAL <br />❑ PARTNERSHIP <br />�j CORPORATION <br />❑ JOINT VENTURE <br />SS: <br />, being duly sworn, deposes and says: <br />That he/she is the party making the foregoing proposal: <br />That he/sire is a member of the co -partnership firm designated as: <br />and who has been and is duly <br />for the co -partnership by: <br />who constitute the other members of the <br />the authority to make and execute instruments <br />That he is of. <br />- s.•.^nof 'rc ^ an.l Fnq'neerinq Inn <br />a corporation which is making the foregoing proposal: <br />That he is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/sire 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 arc: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by <br />collusion to secure advanta e against the City of Santa Ana or any person interested in the <br />proposed contra�t, or himself�orr ny other person. <br />Signature of Bidder <br />Subscribed and sworn to before me this day of __20 <br />Signature of officer Administering Oath (Notary Public) <br />P-7 of P-17 <br />