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23A - PROJ - 1ST ST LIFT STATION
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02/19/2019
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23A - PROJ - 1ST ST LIFT STATION
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Last modified
2/14/2019 4:20:07 PM
Creation date
2/14/2019 4:16:45 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
2/19/2019
Destruction Year
2024
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 19-6495 <br />FIRST STREET UNDERCROSSING STORMWATER LIFT STATION <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />`CIrTY OF SANTA ANA ) <br />being duly swam, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSIUP That he/she is a member of the co -partnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of: Amaz Engineering Contractors, Inc. <br />a corporation which is making the foregoing proposal: <br />❑ JOfNT VENTURE That he is of <br />one of the parties making the foregoing proposal as a joint venture, and the he/she has <br />been and is duly vested with the authority to execute instruments for an on behalf of the <br />parties making said bid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by <br />collusion to secure any advantage against the City of Santa Ana or any person interested in the <br />proposed c act, or himself or tiny other person. <br />SiXtuk,qltidder <br />Subscribed and <br />.,sworn to before me this day of 20 <br />11 <br />Signature of officer Administering Oath (Notary Public) <br />P-6 of P-16 <br />23A-15 <br />
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