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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6833 <br />TRAFFIC SIGNAGE UPGRADE <br />FEDERAL PROJECT NO: IISIPL 5063(157) <br />OWNERSHIP AFFIDAVIT <br />STATE, OP CALTGORNIA ) <br />COUNTY Or+ ORANGE ) SS: <br />CST'Y OF SAINTA ANA ) <br />Mike Rodgers , being cluly sworn, deposes and says: <br />[I INDIVIDUAL That he/she is the party making the foregoing proposal <br />❑ PARTNMRSIIIP That he/she is amember of the co-partoorship firm dosignated as: <br />and who has been and is duly vested with the authority to ranks and execute instruments for the co- <br />phrtneaship by: <br />who constitute the o".hes members of the co-parntorship. <br />[� CORPORATION That he is of: <br />President <br />a corporation which is mnkhag the foregoing proposal:— <br />[] JOINT VENTURE,. That he is of: <br />one of tile pardw ,maidng the foregoing proposal as ajoint venture, and the he/she has been and is duly <br />vested with the authority to excoute instruments for an on behalf of the parties Hulking said bid who are: <br />that such a. bid is genuine and not collusive or sham, and has not in any planner sought by collusion to <br />secure any advantage against the City of Santa Ana or tiny person interested in the proposed contract, for <br />himself or any other person. <br />'42zZ4 <br />Signature Udder Mike Rodgers, President <br />Subscribed and sworn to before me this clay of 20 — <br />SEE ATTACHED <br />Signature of officer Administering Oath (Notary Public) <br />P-6 ol'P-38 <br />23A-12 <br />