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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6882 <br />LOCAL STREET SLURRY SEAL 2016-17 <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: Pavement Coatings Co. <br />Business Address: 10240 San ,sevaine Way, Jurupa Valley, Ca 91752 <br />Business E -Mail Address: dford@pavementcoatings.com <br />Telephone: 714-626-3011 <br />State Contractor's License No. and Class: 3036092 A & C32 <br />License Expiration Date: 09/30/2013 <br />State Dept. of Industrial Relations (DIR) 1000003382Registration No.: <br />State Dept. of Industrial Relations (DIR)6/30/18 <br />DIR)6/30/18 <br />Registration Expira ` at <br />Signed: <br />Title: President <br />P-4 ofP-16 <br />