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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6834 <br />TRAFFIC SIGNAL MODIFICATIONS: 17"' STREET AT ENGLISH STREET, <br />MACARTHUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE <br />AT SULLIVAN STREET, WESTMINSTER AVENUE AT CLINTON STREET <br />FEDERAL PROJECTNO: HSIPL 5063(156) <br />OWNERSHIP AFFIDAVIT <br />S PATE OF CALIFORNIA <br />COUNTY OF ORANGE <br />CITY OF SANTA ANA <br />Van Nguyen <br />❑ INDIVIDUAL <br />❑ PARTNERSHIP <br />Xj CORPORA'I JON <br />SS: <br />being duly sworn. deposer; and says: <br />That he/she is the Party making the foregoing proposal: <br />Thathe/she is a member or the co -partnership firm designated as: <br />and who has been and is duly vested Irith the <br />paruneship by: <br />the other members of the co -partnership, <br />to make and execute instruments for the co - <br />That he is of: <br />President of California Professional Engineering, Inc. <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE ghat he is o <br />one of the parties making the foregoing proposal as a joint centmc, and the he/she Inas been and is duly <br />vested with tine authority to execute instromenta for an on hehnlforthe parties making said bid odial are: <br />that such a bid is genuine andoot collusive or sham, and has not in any manner sought by collusion to <br />secure any a, antage against tl e City of Santa Ana or any person interested in the proposed contract, for <br />himselfot ani o`iIm", <br />Signature of <br />Subscribed and sworn to beforeltne this i day of 1'"''iQ� 20 Imo. <br />6'r <br />Signature of officer Administering Oath (Notary Public) <br />P-8 of P-40 <br />