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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 22-6970 <br />OMNIBUS CONCRETE REPAIRS <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/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 true and correct. <br />Contractor's Name: C/ C m r rGTc C w7strooj on i/ n C <br />Business Address: �Ul%-d ShVCQ'lC/%r Ave • S9irf-g �t y <br />Spri�vr erJ 9av�e <br />� <br />Business E-Mail Address: 1'GIGn-v o kd G <br />Telephone: ((5W) 77-7 • i 7,'a- <br />State Contractor's License No. and Class: 79'0 R 8 cl f1- <br />License Expiration Date: !!t /$tl / 7k <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: l (JOGO C 2 /" <br />State Dept. of Industrial Relations (DR) <br />Registration Expiration Date: <br />Signed: <br />Title: Prc siG -m+ <br />P-4 of P-17 <br />