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Last modified
4/9/2024 12:53:26 PM
Creation date
10/29/2019 3:20:21 PM
Metadata
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Template:
Contracts
Company Name
ROCKFORCE CONSTRUCTION, LLC
Contract #
P 06-3510
Agency
Public Works
Council Approval Date
10/1/2019
Document Relationships
23A - PROJ - BRISTOL ST REHAB
(Attachment)
Path:
\Agenda Packets / Staff Reports\City Council (2004 - Present)\2019\10/01/2019
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 06-3510 <br />SAN LORENZO SEWAGE LIFT STATION <br />OWNERSHIP AFFIDAV <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />being duly sworn, deposes and says; <br />❑ INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP 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 That he is of: <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of: <br />one of the parties making the foregoing proposal as ajoint venture, and the lielshe has been <br />and is duly vested with the authority to execute instruments for an on behalf of the parties <br />' 1 ^ 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 collusion <br />to secure any advantage against the City of Santa Ana or any person interested in the proposed <br />c' t 7ct; for imself or any other person. <br />ignatl o td er <br />Subscribed and sworn to before me this �day of U 20 1 0 . <br />SignatCire of officer ministering Oath (Notary Public) <br />KELSIEMNHIKOGOMES <br />eV COMM #2246178 X <br />R NOTANYpUBtIC.cAiIpORNIA7b <br />MNGEOOUNTY N <br />"* MYOOMM.Opt JUNEit. 1022 <br />P-7 of P-17 <br />
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