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23B - PROJ - STREET SIGNAL
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12/01/2015
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23B - PROJ - STREET SIGNAL
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Last modified
11/25/2015 3:20:58 PM
Creation date
11/25/2015 2:05:50 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
12/1/2015
Destruction Year
2020
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 14.67991 New Traffic Signal on Newhopa St and Camille St <br />PROJECT NO. 14 -6800: Traffic Signal Mod iflcation on Segerstroin Ave and Bear St <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Elizabeth H. Mendoza de McRae, , being duly sworn, deposes and says: <br />❑INDIVIDUAL That he/ she is the party making the foregoing proposal: <br />E] 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 />she <br />CORPORATION That he is of; <br />President /CFO of PTM General Engineering Services, Inc. <br />a corporation which is making the foregoing proposal: <br />❑101NTVENTURE 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 />that s c a bid is genuine and not collusive or sham, and has not in any manner sought by <br />collusl to secure any advantage against the City of Santa Ana or any person interested in the <br />pp ontract, for himself or any other person, <br />Elizabeth H. Mendoza de McRae <br />Presldenf/CFO <br />Signature of Bidder <br />Subscribed and sworn to before me this _ day of 20 <br />Signature of officer Administering Oath h((Notary Public) <br />BP -S <br />23B -18 <br />
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