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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6875 <br />CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES <br />FEDERAL PROJECT NO: HSIPL 5063(188) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA-ANNA <br />) <br />FarrW 1- ► agi lyf- FVOJtc1dr* <br />dA Cal OIV . , being duly sworn, deposes and says: <br />❑ INDIVIDUAL <br />That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP <br />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 <br />at he is of, <br />�nternatlonal Line Builder's, Inc. <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That he is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/she has <br />been and is duly vested with the authority to execute instruments for an on behalf of the <br />parties 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 <br />collusi secure any advantage against the City of Santa Ana or any person interested in the <br />propos ontract, f self or any other person. <br />_ n <br />Signature of Bidder {7�oJldtrlF- t/b ('jal piv <br />Subscribed and sworn to before me this day of <br />See& q� Fa cl ►ed . <br />Signature of o er Administering Oath (Notary Public) <br />20A-13 <br />P-6 of P-38 <br />