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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 />C <br />Business Address: �JW lt-ViAe d. I/'/Q IEy;Ke Ci <br />Business E -Mail <br />Address: •A�.�Ih t2dhC�hs I rw'f oh l° <br />Telephone: q l- Z00 - /,900 <br />State Contractor's License No, and Class: % 7 t-% Li YY <br />License <br />Expiration Date: 21 - <br />State <br />3' <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 10000074/ <br />State Dept. of Industrial Relations (DIR) / <br />Registration Expiration Date: ,� 47 - 3 0 - 1z. <br />Signed: <br />Title; <br />P-4 of P-15 <br />