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<br />CITY OF SANTA ANA <br /> <br />RESIDENTIAL STREET REPAIR <br />RECONSTRUCTION -PHASE 12 <br />PROJECT NO. 106718 <br />PROPOSAL AND CONTRACT AGREEMENT <br />CONTRACTOR'S LICENSING STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that the following is <br />true and correct. <br />Contractor's Name: <br />Business Address: j~.(~ . ~o ~~~ ~~~ r~Q~~ q~, g~ g - ~ ~~o~ <br />Telephone: Lq 5i~ -~ ?, ~, 7 ta(~ <br />State Contractor's License No. and <br />Class: ~ f~ ~7 D'J ~ ~ ~ C'-1 ~- <br />Expiration <br />Date: ~ -3 ~- <br />~~ <br />Si <br />~ "l~ Off" ~r~ed~ c~ <br />Title: ~(j Lip Pr~~i ,a~rn-~ <br />• <br />TO BE INCLUDED IN BID PACKAGE <br />BP 14 of 14 <br />