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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15-6830: Pedestrian Countdown Ileads and Push Buttons <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE )s5'. <br />CITY OF SANTA ANA } <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 himself or any other person. / <br />e <br />gnature er "a�T;s34aj "'�p,(,s aD401-Aror a& rvdc�c <br />Subscribed and sworn to before me this day of 20 <br />Signature of officer Administering Oath ( <br />BP -6 <br />being duly sworn, deposes and says: <br />❑INDIVIDUAL <br />That he/she is the party 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 <br />Instruments for the co -partnership by: <br />who constitute the other members of the co -partnership v <br />,'+]CORPORATION <br />That he is of: <br />SIEMENS INDUSTRY, INC. <br />a corporation which is making the foregoing proposal: <br />❑JOINT VENTURE <br />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 contract, for himself or any other person. / <br />e <br />gnature er "a�T;s34aj "'�p,(,s aD401-Aror a& rvdc�c <br />Subscribed and sworn to before me this day of 20 <br />Signature of officer Administering Oath ( <br />BP -6 <br />