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23A - PROJ - DELHI CHANNEL PROJECT
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12/06/2016
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23A - PROJ - DELHI CHANNEL PROJECT
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Last modified
12/1/2016 4:04:21 PM
Creation date
12/1/2016 3:51:56 PM
Metadata
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
12/6/2016
Destruction Year
2021
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CITY OF SANTA ANA <br />PROJECT NO. 16-6467 <br />SANTA ANADELHI CHANVEL DIVE <br />W <br />4-11QU01 "21 <br />(ADDENDUM ONE ` JULY 22, 2016) <br />QWNFAS1111' AFFIDAVIT <br />SIA 11; OF CAI.IFQ)iZMA ). <br />"j C.l IN 017 SANTA ANA ') <br />m1. _, „P4%_ 1`1 -- $i f'? . L' bf l . -king duly axon, dcposiv, ssntt x�zys: <br />[� INDIVIDUAL 'that helshc!. the fwty� snaking, iln_ tiarsnoinr peattxaMd: <br />j� j 8'AWINF'RSHIP '@ hat tWsfic !� a =1111vr of1he til-pastncrship firm dcsignatud us: <br />40114 who hd& I vii and to duly Y0,slcd milk the anlltorily to mgke and vxcoae insu cn15 <br />lana dtc co -parte mbip by; <br />+ 7i o can tiwc 1L ut@ter nu:smh'ure ni`the ctriutnsr:,hip <br />0101ft1iM ION That he k oil <br />as corlxsratinn 1ahls,It 04 asaakdns t11u I"rsrarroing pcngxs:att: <br />DJCklhtrVId NIttkiz -mitt lie isolt <br />acne nC dile 1+rort1c.5 nntking E 14 ftsrsaguing pe 5rxa;,11 as a joint vt ntl1w, alld the hcashc 1ta, <br />hem .and is dsdu arstcc! w[rh Ihc aallho€nly law ewcute hnwtntaoun1s fur :en 44n behalr¢1f'the <br />parsdes making said bid w63 a : <br />Ilialsuch a bid is blennine and not collnsirre or shale, and has not its any manner sought by <br />collusion to secure any aelvamage against the City or Santa Ana or any person intemstetl in the <br />used ectti ct, l'or himself or tray other parson. <br />Si�.!nerlerre of8it i&i= <br />Stlhscf ibcd and sworn it) before me Ili Is clay car-- - 21.1 <br />Signzaturc of ofliccr Administering Oath (Notary public) <br />Gity of ,Santa Ana i Projr[;I 15-646% Sanla AwV—YIb fpar�lqpl Diversion Project 1 R Blf.l C:dohr:r 1, 20'16 <br />23A-13 <br />
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