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M, Am <br />PROJECT NO. 15 -6828 <br />Harbor Boulevard Corridor Traffic Signal Improvements <br />(as part of Harbor Blvd Traffic Signal Synchronization Project) <br />OWNERSHIP AFFIDAVIT <br />STATEOFWXtf=K% Pennsylvania <br />COUNTY OF RWW Montgorneh5¢ <br />CITY OF SANTA ANA } <br />Gregory W. I- Iolman, being duly sworn, deposes and says: <br />❑INDIVIDUAL That he/she Is the patty making the foregoing proposal: <br />Q PARTNERSHIP That he /she is a member of the co•parmersh)p 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 copartnership, <br />[CORPORATION That he is of: <br />j - Vice President <br />a corporation which is making the foregoing proposal: <br />[3JOINTVENTURE 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 Did who are; <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 ""tract, for himss or any other person. <br />Signature of BI Gregory Hol vice President <br />j1u15rib d and sworn to before me this day ofR-lo 20 <br />Signature wer Ad 's erl t " a blic) <br />COMMONWEALTH OF PENNSYLVANIA <br />NOTARIAL SEAL <br />KIMBERLY S. WILEY, Notary Pttblk <br />N My Commt�sstonPExP 1 41 JM <br />23A -18 <br />