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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6859 <br />LOCAL STREET SLURRY SEAL 2015-16 <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 Industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: RT12.pC4\E'M 'MarMAt s 1n OVA'r10nj , LLC <br />Business Address: fol (o o =NNoVA71ON CA(LL.$BAD , CA .92009 <br />Business E -Mail Address: <br />Telephone: (-7c o) 4,03-01(o I <br />State Contractor's License No. and Class: 9q 1 274 A. i C.32— <br />License Expiration Date: 03 1311 2f)V6 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: t woo ZOB <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: Ob l3dl 20110 <br />Signed: <br />Title: c • r a <br />P-4 of P-16 <br />