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CITY OF SANTA ANA <br />PROJECT NO. 16-6467 <br />SANTA ANA DELHI CHANNEL DIVERSION PROJECT <br />PROPOSAL <br />(ADDENDUM ONE - JULY 22, 2016) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />be— k -GA �'�� J A-lJ a ✓ 1^ C , being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making 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 <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />(CORPORATION That be is of: PQ-e-iiMErPT O <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of: <br />one of the parties making 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 />es d c ntr ct, for himself or any other person. <br />C!h y4- <br />Signature of$id <br />Subscribed and sworn to before me this day of <br />Signature of officer Administering Oath (Notary Public) <br />20 <br />City of Santa Ana / Project 16-6467 Santa Ana %fit atltr I Diversion Project / REBID - October 7, 2016 <br />