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EXHIBIT 12 (cont.) <br />4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any Technical assistance <br />related to [lie plans, specifications and requirements for the work which was provided to W/MBE: <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance <br />agencies: <br />I A/are under penally gfperjury that the foregoing iglbrination is true and correct to the heat of my knowledge, I <br />mulerstand that the City ofSanta Ana and/or the US, DepuMnent of Housing and Urban Develolmiew may verify <br />the ua%prmatign iironided herein in connectlon with W/IM conrpllance evatuationlaudit activities and thai fidlure <br />to fully and truth idlycomplele this form may result in economic or other sanctions: <br />O`J 0 <br />Signature: <br />Name: <br />I Vi t. uc / <br />Titte: <br />044 o+6400w'i <br />Date: <br />rn xY "Zai9 <br />Name of 4z,h-actw 'abeoatractor: <br />y/a L> a S A'-MAIr:w C-rl, /,.t e. <br />Contracto-/Subeontraetau, Identification <br />Number: � S' - 3 l P V <br />Address (Street, City, State, Zip): 647- 9 lglb a 'bs P <br />+9tA_- 7 C4j",*roNG4r CA 6117 of <br />Business Racial/Lthale/Gender Code: <br />Circle Nio numeHo code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51 % <br />of the business. Wbcn 5l% or more is not owned and controlled by any single rarciai/elunielty/gcuder category, <br />circle the code which scems most appropriate. <br />(�)= White Americans <br />2 = Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: <br />Ycs or <br />4 = Hispanic Americans <br />5 = Asian/Pacitie Americans <br />6 = I lasidie Jews <br />P.fDOCS%PROPSVCSWUDFORMS\MOU5BO4AMB-8edm38pe.$DOC <br />23A-46 <br />