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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 the 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 />ONE o,'F r. Fa r — PEA or -A. ic a r 5 to " <br />I declare tinder penalty of perjury that the foregoing information is true and correct to the best of my knowledge. I <br />understand that the City of Santa Ana and/or the U.S. Department of Housing and Urban Development may verify <br />the information provided herein in connection with W/MBE compliance evaluation/audit activities and that failure <br />to f dly and truthfully complete this form may result in economic or other sanctions. <br />Signature: <br />No <br />t t_ t-lc <br />Title: <br />/K$IPBNT - <br />Date: <br />M s 4 -to lg <br />Name of rttactot 'ubconh•actm•: <br />VIL>o <br />SA�++r}R2t�rl i �c <br />Contructor/Subcontractor Identification <br />Number: <br />cjs_7g1)v$y <br />Address (Street, City, State, Zip): <br />687 9 <br />Al Lf—l'-b S p LeKE <br />/w/.1C HJ <br />r. ,,4,no NbA CA °l1'7 vl <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 51 % <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 />White Americans <br />2 = Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: <br />Fvc-sk or <br />4 = Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = Hasidic Jews <br />F9[=S"0PSVCS W UOFORMS%M8U5B04PMB - SecllonMpeuDOC <br />