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CITY OF SANTA ANA <br />PROPOSAL <br />PRQJECTNW 21-7535, 21-7534, 21-7535 <br />CAMPESINO PARK, MEMORIAL PARK, & MADISON PARK RESTROOMS <br />O TRACTOR"S LICLNSING AND REGISTRATJQN STATENI T <br />The undersigned contractor, or corporate officer, declares tinder pea❑lty or perjury dint Inc/she <br />and all his/her subcontractors are registered with the State of California Department of Industrial <br />Relations (DIR), and that the following is tare and correct. <br />Contractor's Name: 1a4L) OkAe ft 'r t <br />Business Address; 540 c <br />Business E-Mail Address: -t r�YCIt[k igQib <br />Telephone; <br />State Contractor's License No. and Glaser <br />, <br />License Expiration Date; ?1 ., ? <br />State Dept. of Industrial Relatio❑s (DIR) <br />Registration No., I aee2 <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiratick l�atc&,,, ? l <br />Signed, <br />Title. Hi'iA'v`` <br />p_il of P-17 <br />