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CITY OF SANTA ANA <br />RFP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA i <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Curtis P. Brown III <br />being duly sworn, deposes and says: <br />❑.TNMIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is a member of the oo-partnership fum designated as: <br />and who has been and is duly vostcdwith the authority to mske and execute instruments for the co parmership <br />by: <br />who constitute the other members of the co -partnership. <br />M/CORPORATION That he is of Pn iunmT PALIy INC DSA <br />❑ JOINT VENTURE <br />That he is of <br />one of the parties making the foregoing proposal as a jobt venture, and the helshehasbeen and is duly vested <br />with the authority to execute instruments for an on behalf ofthe parties making said bid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any <br />advantage against the City of Santa Ana or any person interested in the proposed contract, for himself or any other <br />person. <br />SOL- Curtis p. Brown III <br />Sig ire of CONTRACTOR president <br />Subscribed and sworn to befo a this _ � � " Illy of <br />Signature of officer Adminis ing Oath (Notary Public) <br />i <br />20 <br />Page 3 of 10 <br />