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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6862 <br />CABRILLO PARK SIDEWALK IMPROVEMENTS <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: W -A CO,(f1 `4 ((AC f O Y� CO (`{7 <br />� <br />Business Address: OZ01 `�foo'e�,6',een C'/ Vauyi'Ecl c' qa 7� <br />Business E -Mail Address: e 11 a�) U I <br />Telephone: r�yr (06GI— 21 j <br />State Contractor's License No. and Class:96123� S C-21) L-10AC-1Z <br />License Expiration Date: 6/3 � / 18 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 10f95C>005oy <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />Signed: <br />P-4 of P-16 <br />