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CITY OF SANTA ANA <br />RCP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />C NTRACTOR'S LLCENSINGAND REGIS R Tl TATAMI3NT <br />The undersigned contractor, or corporate officer, declares under penalty or perjury that lie/she and all his/her <br />subcontractors are registered with the State of California Department or Industrial Relations (DIR), and that the <br />rollowing is true and correct. <br />Contractor's Name: Vldo Samarzich, Inc. <br />Business Address: 6829 Billings Place, Rancho Cucamonga CA 91701 <br />BusinessE-Mail Address: vidosam@yahoo.com <br />Telephone: (909) 987-6377 <br />State Contractor's License No, and Class: 433210 A <br />License Expiration Date: 12/31/2024 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 1000013213 <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration D�te: 06/30/2023 <br />1 ,. I e <br />Signed: <br />Title: Vice President <br />Page I of 10 <br />