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Last modified
6/5/2024 10:17:50 AM
Creation date
7/10/2019 12:24:18 PM
Metadata
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Template:
Contracts
Company Name
T.E. ROBERTS INC.
Contract #
P 11-6413
Agency
Public Works
Council Approval Date
4/2/2019
Notes
Project
Document Relationships
23A - PROJ - SA-5 VAULT MOD
(Attachment)
Path:
\Agenda Packets / Staff Reports\City Council (2004 - Present)\2019\04/02/2019
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 11-6413 <br />SA-5 VAULT MODIFICATIONS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANT-A-'ANA C*- n , f ) <br />TI Mp � <br />KI) b-,r t s being duly sworn, deposes and says: <br />❑INDIVIDUAL <br />That he/she isthe party making the foregoing proposal: <br />❑ PARTNERSHIP <br />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 <br />instruments for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />'CORPORATION <br />That he is of: <br />ertsIAen o� <br />T.E. iLObari-s INS <br />a corporation which is making the foregoing proposal: <br />❑JOINTVENTURE <br />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 <br />the 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 />prq o5 _c ntract, for m f- any other person. <br />Signature of Bidder 'nmo+c y P_obert5 <br />Subscribed and sworn to before me this Iq4rh day of �&niiwj 20 ii <br />um" AA <br />Signature of officer Administering Oath (Notary Public) <br />P-7 OF P-16 <br />
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