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OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />COUNTY OF ORANGE <br />CITY OF SANTA ANA <br />Vido Artukovich <br />CITY OF SANTA ANA <br />PROPOSAL <br />SS: <br />being dulysworn, deposes and says: <br />[] INDIVIDUAL That he/she is the party making theforegoing proposal: <br />0 PARTNERSHIP 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 <br />Instruments for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />[]CORPORATION That he is of: <br />a corporation which is making the foregoing proposal: <br />NJOINT 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 />Vido Artukovich & Son, Inc./Vidmar, Inc. A JV <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 />a� <br />Signature of Bidder <br />CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE 8202 <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed <br />the document to which this certificate is attached and not the truthfulness accuracy, or validity of that document. - <br />State of California <br />County of Los Angeles <br />Subscribed and sworn to (or affirmed) before me on this 16th of September, 2015 by Vido Artukovich, proved to me on the basis of <br />satisfactory evidence to be the person who appeared before me. o <br />6WON ART MOVICH c I r1 - Oo- <br />ConlmNtHxe id 2121646 <br />NogryPal6Ne•CaIBorala Signature <br />Lo`i AnnNr Co" t <br />