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CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all <br />his/her subcontractors are registered with the State of California Department of Industrial Relations (DIR), <br />and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E-Mail Address: <br />Telephone: <br />State Contractor's License No. and Class: <br />License Expiration Date: <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />Signed: <br />Title: <br />City of Santa Ana RFP 23-182 <br />Page A3-5 <br />