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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 />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTYOFORANGE )SS: <br />CITY OF SANTA ANA } <br />C.P. aflowN being duly sworn, deposes and says: <br />❑INDIVIDUAL That he/she is the party making the foregoing proposal: <br />F-1 PARTNERSHIP That he/she is amemberofthe co -partnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute <br />instruments for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of: RALR MOM <br />PRBIDENT Ez.XMI RXIANI got <br />a corporation which is.. making the foregoing proposal: <br />❑JOINT VENTURE That he Is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/she has <br />been and is duly vested with the authority to execute Instruments for an on behalf of <br />the parties making said bid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any manner sought by <br />collusion to secure any advantage against the City of Santa Ana or any person interested in the <br />proposed contract, for himself or any other person. <br />Signature of Bidder 0,P, BRo ffi, PRESIDENT <br />mm' ]�'1115 <br />Subscribed and sworn to before me this day of 20 <br />Signature of officer ministering Oath (Notary Public) <br />C. PHILLIPS I( <br />D{� � COMM. n14�3C--1'77 r� <br />vy+ i'��' tJotatY PublloQalitnen .f N <br />qq � LOS ANGELESCDONlY a <br />`^ " My Comm.fxpims Ocl.29,20161I <br />BP -7 of 17 <br />23A-21 <br />