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CITY OF SANTA ANA RE -BID <br />PROPOSAL <br />PROJECT NO. 16-7523 <br />WASHINGTON SQUARE RESIDENTIAL STREET REPAIR <br />4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any <br />technical assistance related to the plans, specifications and requirements for the work which <br />was provided to W/MBE: <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with <br />W/MBE assistance agencies: <br />I declare under penalty of perjury that the foregoing information is true and correct to the best <br />of my knowledge. I understand that the City of Santa Ana and/or the U.S. Department of <br />Housing and Urban Development may verify the information provided herein in connection with <br />W/MBE compliance evaluation/audit activities and that failure to fully and truthfully complete <br />this form may result in econ tc or other sanctions. <br />12/23/15 <br />Si re Date <br />Name: <br />Title: <br />JOSEPH A NANCI <br />Name of Contractor/Subcontractor: EBS GENERAL ENGINEERING INC <br />Contractor/Subcontractor Identification Number: <br />Address (Street, City, State, Zip): <br />33-0634599 <br />1320 E SIXTH ST, STE 100 CORONA CA 92879 <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and <br />controller(s) of 51% of the business. When 51% or more is not owned and controlled by any <br />single racial/ethnicity/gender category, circle the code which seems most appropriate. <br />= White American <br />2 =Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: Yes <br />4 = Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = Hasidic Jews <br />or No <br />P-23 of P-25 <br />