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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 19-6943 <br />BRISTOL ST. REHABILITATION: MACARTHUR BLVD. TO RAILROAD (N. OF <br />ALTON AVE.) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF aRMME Riverside ) SS: <br />CITY OF SANTA ANACorona ) <br />Edward J. Carlson , 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-parmership. <br />❑x CORPORATION That he is of <br />Vice President of All Arneoran Asphalt <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 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, for himself or a y other person. <br />Signa re of Bidder Edward J. Carlson, Vice President <br />Subscribed and sworn to be me this day of 20 <br />—P11W18SeeA whe <br />Signature of officer Administering Oath�tary Public) <br />P-7 of P-17 <br />23B-14 <br />