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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6839 <br />LOCAL STREET SLURRY SEAL 2014-15 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF QRANGH <br />RIVERSIDE) SS: <br />CITY OF SANT-A-AN-,4 CORONA ) <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 firm designated as: <br />and who has been and is duly 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 />CORPORATION <br />That he is of,. <br />ALL AMERICAN ASPHALT <br />a corporation which is malting the foregoing proposal: <br />❑ JOINT VENTURE <br />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 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 himself or any other person. <br />Signature of B der EDWARD J. CARLSON, VICE PRESIDENT <br />Subscribed and sworn to before me this ay of <br />Signature of officer Administering Oath (Notary Public) <br />f, <br />BP6of16 <br />20 <br />