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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 22-6970 <br />OMNIBUS CONCRETE REPAIRS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Oh n C • J C4 r/7 a , being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/eke is the party making the foregoing proposal: <br />❑ PARTNERSHIP That hcl"is a member of the co -partnership firm designated as: <br />and who has been and is duty vested with the authority to make and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />[J�CORPORAI'ION That prijident 0-f— CT CehCre <br />tc Can S*rvo7Yc*7, /r, <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 <br />been and is duly vested with the authority to execute instruments for an on behalf of the <br />parties making said hid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any inanner sought by <br />collusion to secure any advantage against the City of Santa Ana or any person interested in the <br />proposed contract, for himself or any other person. <br />Signattt(eof der <br />Subscribed and sworn to before m this a �h q' day of cW h b*' 20 <br />A" <br />Signature of officer Administe ath (Notary Public) <br />SANACHEL ANDREAJIMENEZ <br />Notary Public - California <br />Los Angeles County y <br />Commission R 2305370 <br />y Comm. Expires Sep 15, 20t3 - <br />P-6 of P-17 <br />