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OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA ANA <br />) <br />Timothy ►Zo b e r <br />t s being duly swom, 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 for the co- <br />partnership by: <br />who constitute the other members of the co -partnership. <br />M CORPORATION <br />That he is of: <br />T.E. Roberts, 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 been and is <br />duly vested with the authority to execute instruments for an on behalf of the parties making said bid <br />who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to <br />secure any advanta a against the City of Santa Ana or any person interested in the proposed contract, for <br />self or any er �ese <br />Signature of CONTRACTORTimctby <br />Subscribed and sworn <br />to before me this �� day of QMVWY 20� <br />UAw, , " LrL6Q ��l <br />Signature of officer Administering Oath (Notary Public) <br />S-e-e aO-A'ched <br />City of Santa Ana RFP 20-106 <br />25%7 � <br />\-I <br />