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CITY OF SANTA ANA ADDENDUM ONE <br />PROPOSAL <br />PROJECT NO.: 20-7533 <br />RESIDENTIAL STREET REPAIR PROGRAM FY 19/20 <br />HENINGER PARK NEIGHBORHOOD <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA ANA <br />) <br />Vido L. Samarzich <br />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 consbtute the other members of the co -partnership. <br />CORPORATION <br />That he is of: <br />Vido Samarzich, 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 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/ Qoii <br />If or any other person. <br />Signaturr <br />Subscribed and sworn to before me this day of <br />Signature of officer Administering Oath (Notary Public) <br />20 <br />P-6 of P-17 <br />