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23B - PROJ - BICYCLE BLVDS
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11/15/2016
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23B - PROJ - BICYCLE BLVDS
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Last modified
11/10/2016 3:51:23 PM
Creation date
11/10/2016 3:43:35 PM
Metadata
Fields
Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
11/15/2016
Destruction Year
2021
Document Relationships
EXCEL PAVING COMPANY
(Amended By)
Path:
\Contracts / Agreements\ PROJECTS
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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6848 <br />BISHOP-PACIFIC-SHEL"I'ON BIKE BLVDS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />)SS - <br />SS:CITY <br />CITY OF SANTA ANA <br />) <br />00MM. 0,1996171 <br />C. Po 8P'0"N <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 />k <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />LJ CORPORATION <br />That le is of:PREMENT <br />a corporation which is making the foregoing proposal: <br />© JOINT VENTURE <br />That he is of: <br />one of (lie parties making the foregoing proposal as a joint venture, and the lielshe has <br />been and is duly vested with the authority to execute instruments 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 />Signature of Bidder <br />Subscribed and sworn to before me this day of a,- nn r 20 <br />1 <br />Signature of offi t <br />Administering Oath (Notary Public) <br />P-8 of P-18 <br />23B-15 <br />. PHICUP8 <br />00MM. 0,1996171 <br />N <br />Notary Publiccolifornlo <br />tk <br />^ k <br />" <br />LOS AN01M.C5 COUNTY <br />My comm. Rates bet. 29.2019 <br />k <br />P-8 of P-18 <br />23B-15 <br />
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