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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6437 <br />CITYWIDE SEWER MAIN IMPROVEMENTS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />�CIITTY,,,O,F�S,A'N1TAAA,N�A�,�,��� � ) <br />`- wa# 1,_� /r t7L—t 4 , being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the puny making the foregoing proposal: <br />❑ PARTNERSIIIP 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 Th�t he is <br />J• <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is oL' <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 con et, for himself or any other person. <br />gnature of Bidder <br />Subscribed and swom to before me this day of 20 <br />.7l-C.TYfl3 <br />Signature of officer Administering Oath (Notary Public) <br />