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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 11 -6416 <br />SEVENTEENTH STREET WATER MAIN IMPROVEMENTS <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: <br />Business Address: <br />Telephone: 7/� 3Z" 797-5 <br />State Contractor's License No. and Class: <br />Expiration Date: <br />Signed: <br />Title: <br />S eobun 3 - a P.,OS.l 09 -22 -2014 <br />P -ld <br />23A -28 <br />r, n <br />