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CITY OF SANTA ANA ADDENDUM TWO <br />PROPOSAL <br />PROJECT NO.: 17-6880 <br />SANTA ANA BOULEVARD AND 5TH STREET PROTECTED BIKE LANE <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and <br />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 Samarzich, Inc <br />Business Address: 6829 Billings Place, Rancho Cucamonga, CA 91701 <br />Business E-Mail Address: Vldosam@yahoo.com <br />Telephone: (909) 987-6377 <br />State Contractor's License No. and Class: 433210 Class A <br />License Expiration Date: <br />12/31 /2020 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) <br />Registration ExWatio4Dgte: <br />Signed: <br />Title: Vice President <br />1000013213 <br />6/30/2020 <br />i6Cp* <br />