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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6862 <br />CABRILL,O PARK SIDEWALK IMPROVEMENTS <br />CONTRACTOR'S LICENSING AND REGISTRATfON STATEMENT <br />The undersigned contractor, or corporate officer, declares wider 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: 1 t :�p �(/_ on �i' �(AC+i ©rti CQ (� r � �j.__ <br />Business Address: ULG l fGo�R`een IZ? r✓�yi"eA Gl %0Z��o <br />Business E -Mail Adcless: 7', (i CA`50 <br />Telephone: 6(01 (6CI— <br />State Contractor's License No. and Class: <br />License Expiration Date: 6/3 � / 18 -- <br />State Dept, of Industrial Relations (DIR) <br />Registration No.: l 000c,00505a <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />Signed: <br />Title: <br />P-4 of P-16 <br />23A-70 <br />