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EXHIBIT 12 (cant,) <br />4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any technical assistance <br />related to the plans, specifications and requirements for the work which was provided to W/MBE: <br />S. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance <br />agencies: <br />I declare under penalty ofperjury that the foregoing information is true and correct to the best of my knowledge. I <br />understand that the City of Santa Ana and/or "the U.S. Department ofFlousing and Urban Development may verify <br />the information provided herein in connection with W /MBE compliance evaluationlaudit activities and that failure <br />to fully and truthfully complete this form may result in economic or other sanctions. <br />Signature: <br />Name: <br />Title: <br />kaeli (SAoT <br />Date: <br />-- t 5 <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the racial /ethnic /gender character of the owner(s) and controller(s) of 51% <br />of the business. When 51% or more is not owned and controlled by any single raeial/ethnicitylgender category, <br />circle the code which seems most appropriate. <br />White Americans <br />2 = Black Americans <br />3 =Native Americans <br />Woman Owned Business: <br />4 = Hispanic Americans <br />5 = Asian /Pacific Americans <br />6 = Hasidic Jews <br />Circle One: <br />Yes or No <br />F:% DOCS�PROPSVCS�HUDFORMSIMBU5B04AMB- S.d.OSP.M.DOC 23✓-43 <br />