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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16 -6859 <br />LOCAL STREET SLURRY SEAL 201.5 -16 <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 Depa3unent of Industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: PeV10 Lrh PV\A1W —iA"s 3a NOVAMOn1 , LLC <br />Business Address: (ni%S SNNoJA-x10N WA. of- LSBAca ,CA• (12.00`i <br />Business E -Mail Address: -Go,- Y, z pffy k -ednno 10,E -C_oyv , _ <br />Telephone: Ci (.0) to03 -0` 61 <br />State Contractor's License No. and Class: 991 ZeI4 A � C.32— <br />License Expiration Date: 03 131/ 2°b10s, <br />State Dept. of Industrial. Relations (DIR) +7 �} <br />Registration No.: , 00M I I ZOS <br />State Dept. of Industrial Relations (DIR) <br />Registration ExLration Date: OG,13�1 zo i LQ <br />Signed: <br />Title: C • r 6). <br />P -4 of P -16 <br />23A -10 <br />