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CI'T'Y OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15-6840: WARNED AVENUE PAVEMENT MAINTENANCE <br />PROTECT NO. 16-6858: FIRST STREET PAVEMENT MAINTENANCE <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she <br />and all his/her subcontractors are registered with the State of California Department of industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E -Mail Address:,\��,���,��,(�������her,�,�,,,n� ,rte w <br />Telephone: <br />State Contractor's License No, and Class:l�"11��1?a C l2 <br />License Expiration Date: 2,\ <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: _ TL";CY`C 2a\ <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: 1j Ll -,D <br />Zvi <br />Signed: x`51 ' <br />Title: <br />P-5 of P- l 7 <br />