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CITY OF SANTA ANA <br />INSTRUCTIONS TO BIDDERS <br />PROJECTNO.: 21-6458 <br />MISCELLANEAOUS STORMDRAIN REPAIRS <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: <br />LOTOMMITIM <br />Business Address: LONG BEACH CA 90806 <br />Business E-Mail Address: satbAfinaMesavina,asi <br />Telephone: 562) 699-6841 <br />STATE LIC# 688659 <br />State Contractor's License No. and Class: A C:12, C31 <br />License Expiration Date: Y%a h U40!22 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: k n 0 ot"1f)sn <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: ( 7?b Z02 Z <br />Signed: <br />Title: Curtis P. Brown III President <br />P-4 of P-17 <br />