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CITY OF SANTA ANA <br />RFP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all his/her <br />subcontractors are registered with the State of California Department of Industrial Relations (DIR), and that the <br />following is true and correct. <br />Contractor's Name: PALP, INC DBA EXCEL PAVING <br />Business Address: LONG BEACH, CA 90808 <br />Business E-Mail Address: a <br />Telephone: 562) 599.5841 <br />State Contractor's License No. and Class: STATE LIC# 698659 <br />License Expiration Date: <br />State Dept. of Industrial Relations (DIR) DIR# 1000003331 <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: so 110 'y5 <br />Signed: <br />Title: )7,urtis P. Brown III President <br />Page 1 of 10 <br />