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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16 -6859 <br />LOCAL STREET SLURRY SEAL 2015 -16 <br />OWNERSHIP AFFIDAVIT <br />SPATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA ANA <br />) <br />FCEAtJ k HoFFiM1 r/ J 5;, O , being duly sworn. deposes and says: <br />%INDIVIDUAL <br />That he/she is the pally making the foregoing proposal: <br />❑ PARTNERSHIP <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 make and execute insbruments <br />for the co- partnership by: <br />who constitute the other members of the co- partnership. <br />❑ CORPORATION <br />That be is of. <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That he is of: <br />one of the parties making tho foregoing proposal as fl joint venture, and the he /she has <br />been and is duly vested with the authority to execute instruments ror an oil behalf of the <br />parties making said bid 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 contract, for him/^sellf'oi any other person. <br />Signature of BA (der <br />Subscribed and sworn to before me this �_ clay of 3 ,/ J 20 110 <br />Signature of officer Administering Oath (Notary Public) <br />P -6 of P -16 <br />23A -12 <br />