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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15-6836: RESIDENTIAL STREET REPAIR FY 14/15 <br />PROJECT 15-6452: WILSHIRE AVE. AND BORCHARD AVE. WATER MAIN IMPROVEMENTS <br />CONTRACTOR'S LICENSING and REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she <br />and all his/her subcontractors are registered with the State of California Department of <br />Industrial Relations (DIR), and that the following is true and correct. <br />Contractor's Name: PAIR INC. DBA EXCEL. Patio GQM y <br />AVENUE <br />Business Address: LUNG BEACH, CAVW06 <br />Business E -Mail <br />Address: <br />Telephone: ( 599-5641 <br />State Contractor's License No, and Class: STATE LIC. 6o065g "A° <br />License <br />Expiration Date: <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: �D(}�J�S <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: (Q I.�)0 <br />Signed: <br />Title: GIF. BROWN. PREMNT <br />13P-5 of 17 <br />23A-19 <br />