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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 19-6942 <br />LOCAL STREET PREVENTATIVE MAINTENANCE FY 2018-19 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA I <br />COUNTY OF ORANGE I SS: <br />CITY OF SANTA ANA I <br />Edward J. Carlson, Vice President being duly shorn, deposes and says: <br />[]INDIVIDUAL That lie/she is the pan)' making the foregoing proposal: <br />❑ PARTNERSI aP That he/she is a member ofthe 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 ol: <br />All American Asphalt <br />a corporation which is making the foregoing proposal: <br />[]JOINTVENTURE That he is or: <br />one of the parties making the foregoing proposal as a joint venture. mid the helshe has <br />been and is duly vested with the authurit) 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 contract, for It ]Itself or any other person. <br />A�— <br />Signature of Bi der <br />Edward J. Carlson, Vice President <br />Subscribed and sworn to before me this o9404-' day of _ 20 /q <br />-x i�aa� �xr fak6AVA4 <br />Signature of officer Administering Oath (Notary Public) <br />P-6 of P-16 <br />23A-33 <br />