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CITY OF ;SANTA ANA <br />SPECIFICATIONS - PROPOSAL <br />PROJECT NO, 16-6849 <br />f;IfTYWIDE CONCRETE IMPROVEMENTS <br />0&JEAC"I'C)R'S, LICEN;iI�ICy Iq I R GIST:[2,1I C7 *T 9TATEM I,[?;fT <br />The undersigned contractor, or corporate officer, declasres under penalty of perjury that he/she <br />and all his/her subcontractors are registered with the State of California Department of Industrial <br />Relations (DIR), and that the following is true and, correct. <br />Contractor's Name: R11 (oI ( ILf, <br />Business Address: <br />Business 13 -Mail <br />Address: <br />Telephone; <br />State. Contractor's License No. and (,�j� <br />Class: .�..J. .V.V q <br />License <br />Expiration <br />Date: <br />State Dept, of Industrial Relations (DIR) �VV�� ��� <br />Registration'INo.: _ _.__ Q <br />State Dept. of Industrial Relations (DIR) <br />Registration °Expiration Date: 17 / <br />Signed: <br />Title: <br />BI'' -5 <br />