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OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />COUNTY OF ORANGE <br />CITY OF SANTA ANA <br />❑ INDIVIDUAL <br />❑ PARTNERSFIIP <br />XCORPORATiON <br />❑ SOINT VENTURE <br />that such a bid is <br />collusion to securt <br />proposed contra,, <br />CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-1305 <br />3R"AND BUSH RESTROOM <br />) SS <br />being duly sworn, deposes and says <br />That he/sho is the party malting the foregoing proposal _ <br />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 male and execute instwi <br />fortheco-partnefshipby:\w\ei <br />who constitute the other members of Cha co -partnership. <br />Thatis of: �; v\"vr ( It C, <br />C' <br />R corporation which is making the foregoing proposal: <br />That he is of: <br />one of the parties malting the foregoing proposal as a joint ventrue, andthe he/she has <br />been and is duly vested with the authority to ox. -cute instruments for an on behalf of the <br />parties making said bid who are: <br />and not collusive or sham, and has not in any manner sought by <br />tntage against the City of Santa Ana or any person interested in the <br />If or any other person. <br />d i1 <br />Subscribed4 d sworn to before me this f day of �l�— 20((-, <br />qa !L'Vtfe,.C.(n.Pr. -� ,�r�"tD'�llta.. juga <br />Signature of officer Administering Oath (Notary Public) <br />P-6 ofP-16 <br />