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Last modified
4/25/2022 9:08:17 AM
Creation date
12/20/2021 10:08:48 AM
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Contracts
Company Name
NOBEST INCORPORATED
Contract #
P 22-7537
Agency
Public Works
Council Approval Date
12/7/2021
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EXHIBIT 12 (cont.) <br />4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any technical assistance <br />related to the plans, specifications and requirements for the work which was provided to W/MBE: <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance <br />agencies: <br />I declare under penalty ofperjury that the foregoing information is true and correct to the best of my knowledge. I <br />understand that the City of Santa Ana and/or the US. Department o Housing and Urban Development may verb <br />the information provided herein in connection with WIMBE comp l anc evaluation/audit activities and that failure <br />to fully and truthfully complete this farm may result in economic or et sanettons. <br />- _. _. <br />I�w�,�►�r/t:�.�i'7rr<a�7t9��`_.iii�.-�.r�r�.: <br />Contractor/Subcontractor Identification <br />Number: <br />(Street, City, State, Zip): <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% <br />of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, <br />circle the code which seems most appropriate. <br />1= White Americans <br />2 = Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: <br />F—Ye-91 or <br />IIMMMMA <br />4 = Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = Hasidic Jews <br />m <br />F90008'PROPSVC3VIUOFORM91M0U5604AMa• 8a WnMpan,000 <br />
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