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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6870 <br />SAFE ROUTES TO SCHOOL ENHANCEMENTS FOR HENINGER ELEMENTARY <br />STATE PROJECT NO: ATPL- 5063(t 59) <br />OWNERSHIP AFFIDAVIT <br />S'I'ATEOF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA <br />Van Nguyen being duly sworn, deposes and says: <br />❑ INDIVIDUAL Tlmt he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is a member of the en -partnership firm designated as: <br />and who has been and is duty vested wall the authority to make and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />FK] CORPORA"FION `That he is of: <br />xeskfL- of Calif sionaLEnginparing,J.nc <br />a corporation which is makiug the tbregoing proposal: <br />❑ JOIN"I' VENTURE; That he is of.. <br />one of the parties making the forcgoing proposal as a joint venture. and the he/she flus <br />been and is duly vested evith the authority to execute instruments for an oil behalf of the <br />parties making saidbid 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 7 advanta e against the City of Santa Ana or any person interested in the <br />proposed contra�t, or him elf orrny other person. <br />Signature of Bidder <br />Subscribed and sworn to before me If is _ day of 20 <br />Signature of officer Administering Oath (Notary Public) <br />P-7 ofP-17 <br />23B-20 <br />