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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 09-3213 <br />CENTENNIAL PARK NEIGHBORHOOD WATER MAIN IMPROVEMENTS <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 />C' <br />g7fO Irvlwe 914 &-bL'10Y Irv;,ie (i "o <br />Se-PQbihbrahCvhstr�;koh• ro <br />Telephone: q L1`✓ - L�O o 7p o O <br />State Contractor's License No, and Class: _% 7 q q y y <br />License ��77 <br />Expiration Date: wL - <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 1 0000 Q 'j t/ b 6 <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: ,� p " 30 <br />0 Z. <br />Signed: <br />Title: <br />P-A ofP-15 <br />23A-10 <br />