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CITY OF SANTA ANA <br />PROJECT NO. 11 -6744: BRISTOL -17TH INTERSECTION WIDENING <br />PROPOSAL AND CONTRACT AGREEMENT <br />CONTRACTOR'S LICENSING STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that the <br />following is true and correct. <br />Contractor's Name: � V� � �/ ® �' -'/`� / Z�_ <br />�/ J �" r� J �, J <br />Business AddrCe�ss: �� `j%� G �I�� /n. �YD�1J .�- c >�"L, ,��, y—�� <br />Telephone : / � � '�- � � S - 6 <br />State Contractor's License No. and `� /'J �,j <br />Class: �j �/ <br />Expiration � _ � v _ 4 <br />Date : n / <br />Signed: <br />Title: <br />c- �- <br />BP 14 of 14 <br />�'-� � � =ter I �i <br />