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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15-6830: Pedestrian Countdown Heads and Push Buttons <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE )SS: <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 />ature�Bf dimer SiWL., pi, I <br />ib �r�ic� <br />Subscribed and sworn to before me thisday of -----2�O <br />Signature of officer Administering Oath <br />:., <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. <br />® CORPORATION <br />That he is of: <br />SIEMENS INDUSTRY, INC. <br />a corporation which is makingthe 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 />ature�Bf dimer SiWL., pi, I <br />ib �r�ic� <br />Subscribed and sworn to before me thisday of -----2�O <br />Signature of officer Administering Oath <br />:., <br />