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23C - PROJ - STREET SLURRY SEAL
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23C - PROJ - STREET SLURRY SEAL
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Last modified
7/6/2015 8:40:47 AM
Creation date
7/2/2015 4:11:38 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23C
Date
7/7/2015
Destruction Year
2020
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15 -6834 <br />LOCAL STREET SLURRY SEAL 2014 -15 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CAT <br />) <br />COUNTY OFoRANGE RIVERSIDE) <br />SS; <br />CITY OF SANT-A-ANA CORONA <br />) <br />EDWARD J. CARLSON <br />- -, being duly sworn, deposes and says: <br />❑ INDIVIDUAL <br />That he /she is the party making the foregoing proposal: <br />❑ PARTNERSHIP <br />That he /she is a member of the co- partnership First designated as: <br />and who has been and is daily vested with the authority to make and execute instruments <br />for the co- partnership by: <br />who constitute the other members of the co- partnership. <br />INCORPORATION <br />That he is of: <br />ALL AMERICAN ASPHALT <br />a corporation which is making the foregoing proposal: <br />❑ JOINT V ENTU RE <br />That lie, is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he /she has <br />been and is duty vested with the authority to execute instruments fur an on behalf of the <br />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 hi If or any other person. <br />Signature of Bidder EDWARD J. CARLSON, VICE PRESIDENT <br />Subscribed and sworn to before me this ay of 20 — <br />Signature of officer Admini ering Oath (Notary Public) <br />BP6of16 <br />23C -18 <br />
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