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CITY OF SANTA ANA <br />PROPOSAL <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 />STATEOF9,At1d=IRiA Pennsylvania <br />COUNTY OF 5tRtIAW Montgome}t5¢ <br />CITY OF SANTA ANA j <br />Gregory W. Holman , being duly sworn, deposes and says: <br />CJ INDIVIDUAL That he/she Is the party making the foregoing proposal: <br />Q PARTNERSHIP That he/she Is a member of the eo•partnership 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 />``y�� /// who constitute the other members of the copartnership, <br />(4fORP� ORATION That he is of: J <br />J Vice President <br />a corporation which is making the foregoing proposal: <br />E]JOINTVENTURE 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 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 ontract, for himse or any other person. <br />Signature Of BI Gregory H0 Vice President <br />Subscribd and sworn to before me this day ofT o 20.LP <br />Signature o Icer Adm' is ering Oat a blic) <br />=W1, <br />OF PES„ NIt�$®VANIa <br />IAL SEAT. <br />LEY, Notary Public <br />, Montgomery CountyExpires igg 9j d01g <br />