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23A - PROJ CENTENNIAL PARK WALKWAY
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10/15/2019
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23A - PROJ CENTENNIAL PARK WALKWAY
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Last modified
10/10/2019 5:12:40 PM
Creation date
10/10/2019 4:55:06 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
10/15/2019
Destruction Year
2024
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EXHIBIT 12 (cont.) <br />4. Efforts made to assist W/MBE in obtaining bonding, lines otcredit or insurance, and any technical assistance <br />related to the plans, specifications and requirements for the work which was provided to W/MBE: <br />Plans and specifications made available on emails or upon request per the advertament free of charge <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance <br />agencies: <br />None <br />I declare under penalty of perjury that the foregoing information is true and correct to the best of nay knowledge. I <br />understand that the City of Saota Ana and/or the U.S. Department of Housing and Urban: Development may verify <br />the information provided herein in connection with DU/hIBB compliance evaluationlaudit activities and that failure <br />to fully and truthful!}+ mplete this form may result in economic or other sanctions. <br />Ai /1 <br />Sienature: <br />Name: <br />Panaglotls Leonlda <br />Title: <br />President, Secretary 8 Treasurer <br />Date: <br />oar27n9 <br />Name of Contractor/Subcontractor: <br />Leonida Builders, Inc. <br />Contractor/Subcontractor Identification <br />CSLB no. 896772 <br />Number: <br />Address (Street, City, State, Zip): <br />15821 Live Oak Springs Canyon Rd, <br />Santa Clarita CA, 91387 <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 5I9ie <br />of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, <br />circle the code which seems most appropriate. <br />I = White Americans <br />2 = Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: <br />Yes or <br />4 = Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = I Iasidic .Jews <br />L® <br />F•DOCSIPROPSVCSIHUDFORMSIMOU5804AMS-5ec[io13SpecyD00 23A-38 <br />
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