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i <br /> i <br /> EXHIBIT 6 <br /> City of Santa Ana <br /> Section 3 Business ConeernEligibility Certificate <br /> Name of Business: <br /> Address of Business;. <br /> Telephone Number: _ � Tax Dumber: <br /> Type of Business, ❑Corporation ❑Partnorship <br /> El Sole,Proprietorship ❑jointVetiture <br /> Section 3 Business Concern ialifyingBasis <br /> 1. 51%owned by Section 3 low-ncoine.rosidents,or <br /> 2. Pennanent,fiill-time employees that include at least 30%o Section.3 low-income or-very low- <br /> incarne:residents;or <br /> 3. Wntten commitment to subcontract with more than 25%of the dollar award of all subcontracts <br /> to be awarded to business concern(s)that meet either of the above(1 or 2)Section 3 <br /> qualification, <br /> Specify Ethnicity and Gentler of Business Owmcrslup(please check one): <br /> ❑American Indian or Alaska Native, ❑ Asian. <br /> ❑ Native Hawaiian or Outer Pacilnte Wandm,,r ❑White <br /> ❑American Indian or Alaska Native and.WWte ❑Asian and.White <br /> ❑Black or African A=rioaa and White ❑:Black or.African.American <br /> ❑ American Indian cr tl lass.Native and Black or Afixcan Arnericati. <br /> .❑ Balance refi7ndividuals repoitiltgmorethan one.race <br /> Gender: <br /> ❑ Male ❑Female <br /> By this signawre afflxcdboreto,Idcalare underpevalty:ofpe�ury that the above information is correct, <br /> Signature of Business Owner Date <br /> Print Name <br /> Received by Date <br />