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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 09-3213 <br />CENTENNIAL PARK NEIGHBORHOOD WATER MAIN IMPROVEMENTS <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 Department of <br />Industrial Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E -Mail <br />Address: <br />2 <br />KC. <br />q7fO k-y;he 914 -(o --`lnY Irene ri 1)42v <br />��t" `� Ill"1 �i��11. `!h -S �i"��L�It7h• �U <br />Telephone: q f - `/D 0 — /opO 0 <br />State Contractor's License No, and Class: -7 q <br />License <br />Expiration Date: a <br />State Dept. of industrial Relations (DIR) <br />Registration No.: 1 0 (0 00 0 7 Y(� <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: 1 3 1 �. <br />� .r <br />Signed: <br />Title: <br />P-4 of P-15 <br />