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CITY OF SA:NTA ANA <br />RPP NO.: 22-096 <br />ON CALL EMERGENCY ASPHALT & PCC <br />OWNERSHIP ArPIDAVIT <br />STATIS OF CALIFORNIA i <br />COUNTY OFORANGF, )W <br />CITY OF SANTA ANA ) <br />Vldtr L Sarargich ,being duly swolit, depnscs and says; <br />[INDIVII)UAL'rllalhe/sheistheipurlymaking tholhragoiagpraposal: <br />�j NAR'I'N13f;,51IIP Thal he/she is o membur oribo eotipul9norsirip Ilrin designated ns: <br />still WILL) Iras boon and is eluIY vosmrl will' din authority to makc add oxide instruments for the co -partnership <br />by: <br />WILL) ecnslitnte tho ogler otoml7oraortl'o oYt•parntership, <br />MICORPORIVI'ION That he is or, <br />A uurpornlion which is raking ilia li rugohtgproposal:.. <br />jj.IOINT vRNTURf That he is or: <br />ono if 1111 praidngthe Fcu'egning proposal ns n io(m venalru, and ihtt lio/sho has buoo and is duly vested <br />wtdl 10 it Illhor4Y to "cisito inslrunianls (bran oil bailalrorthe pmtios rakh1 S it bid who arc; <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 />Signature of CONTRACTOR <br />Subscribed and sworn to before me this day or 20 <br />Signattire of ofter Administering Oath (Notary Public) <br />Page 3 of 10 <br />