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CITY OF SANTA ANA <br />PROPOSAL <br />PROTECT NO.: 16-6859 <br />LOCAL STREET SLURRY SEAL 2015-16 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />��^^--^" CITY OF SANTA ANA ) <br />{^FA,.5 k" k6F- Fr* j r crA , being duty sworn, deposes and says: <br />%INDIVIDUAL That he/she is the party making the foregoing proposal: <br />PARTNERSHIP That he/she is a member of the co -partnership fon designated us: <br />and who has been and is duly vested with the authority to make and exccute instruments <br />forthe co -partnership by: <br />Who constitute the other members of the co-parl'nership. <br />❑ CORPORATION That he is of: <br />a coporation which is making the foregoing proposal: <br />O JOINT' VENTURE That he is of. <br />one of the parties making the foregoing proposal as a joint venture, and the h0she has <br />been and is duly vested with the authority to execute insh'umonts for an on behalf of the <br />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 />CFO <br />Signature of Bic cler <br />Subscribed and sworn to before true this (-g day of <br />Signature of officer Administering Oath (Notary Public) <br />P-6 of P-16 <br />