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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 19-7528 <br />RESIDENTIAL STREET REPAIR PROGRAM FYI 8/19 <br />HENINGER PARK NEIGHBORHOOD <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she <br />and all his/her subcontractors are registered with the State of California Department of Industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: Vido Samarzlch, Inc. <br />Business Address: 6829 Billings Place, Rancho Cucamonga CA 91701 <br />Business E-Mail Address: vidosam@yahoo.com <br />Telephone: (909) 987-6377 <br />State Contractor's License No. and Class: 433210 A <br />License Expiration Date: 12/31/2020 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 1000013213 <br />State Dept. of Industrial Relations (DIR) <br />Registration ExpirAion Pate: 6/30/2020 <br />Signed: <br />Title: Vice President <br />P-4 of P-16 <br />