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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 />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE )SS. <br />CITY OF SANTA ANA ) <br />Vido L. Samarzieh being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That lie/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 VldoSarnarzich, Inc. <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is or: <br />one of the parties making the foregoing proposal as ajoint venture, and the he/she has been <br />and is duly vested with the authority to execute instruments for an on behalf of the parties <br />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 />contract, fa. him syl�r any other person. <br />Signature of Bidder <br />Subscribed Subscribed and sworn to before me this day of 20 <br />SEE ATTACHED JURAT <br />Signature of officer Administering Oath (Notary Public) <br />2PO"tPIb <br />