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OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA l <br />COUNTY OF ORANGE I SS: <br />CITY OF SANTA ANA I <br />I l ir10t-hI F,p 6 e r t s , being duly swom, 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 for the co- <br />partnership by: <br />who constitute the other members of the co -partnership. <br />Q CORPORATION That he is of <br />-T E. Roberts, Inc. <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 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 orse. <br />Signature of CONTRACTOR-rimothy Rnbcrts <br />Subscribed and swom to before me this I q day of Q ch b.Y 209,0 <br />Signature of officer Administering Oath (Notary Public) <br />S-ee ai4-�ched <br />City of Santa Ana RFP 20-106 <br />Page At-25 <br />\-1 <br />