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CITY OF SANTA AIWA <br />PROPOSAL <br />PROJECT N4. 15 -6828 <br />Harbor Boulevard Corridor Traffic Signal Improvements <br />(as part of Harbor Blvd Traffic Signal Synchronization Project) <br />CONTRACTOR'S LICENSING and REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he /she <br />and all his /her subcontractors are registered with the State of California Department of <br />Industrial Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E -Mail <br />Address: <br />Telephone: gam, - Gal0, L' J <br />State Contractor's License No, and Class: 'MO LL0 _ 0,°10 / T <br />License )/ 1 <br />Expiration Date: df i e <br />State Dept, of industrial Relations (DIR) <br />Registration No.: w oboo 1 ' `-. % <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiratiop Date: <br />Signed: <br />.. <br />Title: Greg W. Holman, Vice President <br />11 P <br />23A -16 <br />