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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6871 <br />SAFE: ROUTES TO SCHOOL ENHACEMENTS FOR KING ELEMENTARY <br />STATE PROJECT NO: ATPL- 5063 (160) <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />Cl I OF SANTA ANA ) <br />Van Nguyen being duly sworn. deposes and says: <br />❑INDIVIDUAL "fltathe/she lsthe petty makingthe foregoing proposal: <br />© PAR'FNERSHlp That he/she is a momberorthe co•parinership firm designated as: <br />and who has been and Is duly vested with the authority to make and execute iust'rumenfs <br />for the co-partmmship by: <br />who congtitutc the other members of the co-ptutnership. <br />CO RPO RA'I'L ONTtat he is olt <br />Oresldent of California Professional Engineering, Inc. _ <br />it cognu:ition which is making the faregaing proposal: <br />❑ JOIN "I' VEN'T'URE That lie is of <br />one of the parties making the loregoing proposal as a joint Venture, and the he/she has <br />been and is dulp vested with the authority to execute inshvments for an on behalrorthe <br />parties making said bid who eu�e: <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 hiTa vantage against the City of Santa Ana or any person interested in the <br />proposed contract, fot�pJ`setfiRr aVy other person. <br />Signature of Bidder <br />Subscribed and sworn to before me d s day of <br />Signature of officer Administering Oath (Notary Public) <br />P-7 of P-17 <br />20 _ <br />