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CITY OF SANTA ANA <br />ProjectNo. 14 -6798: 2013 -2014 Omnibus Concrete Replacement Contract <br />PROPOSAL, AND CONTRACT AGRb ,ML I" <br />CONTRACTOR'S LICGNS.INC;,STA "F.,,'MENT <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 />t <br />Business Address: /�• $ t f t „yt g2 ( �� `ZY Z ,._Zhn CA <br />l'elephone: Y-4 <br />State Contractor's License No. and ( 7 <br />Class: ,° 3 C f — <br />I'xpiration <br />Dale: <br />Signed: <br />'I itle: / %VN <br />Iii' 16 of 16 <br />