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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6848 <br />BISHOP-PACIFIC-SHELTON BIKE BLVDS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: " <br />CITY OF SANTA ANA <br />) <br />Notary Public-Callfarnia <br />G.P. "091MN <br />LOS ANGELES COUNTY u <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 />and who has been and is duly vested with the authority to make and execute instruments <br />for the co -partnership by: <br />1 <br />CORPORATION <br />who constitute the other members of the co -partnership. <br />U <br />That he is of: PALF IMCMA <br />r <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That he is of: <br />one of the parties making the foregoing proposal as a joint venture, and the he/she 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 />1 <br />Signature of Bidder <br />Subscribed ands orn to before me this day of 20 <br />V n16 <br />Signature' f offi e Administering Oath (Notary Public) <br />C, PH LLIPSS <br />COMM. 01996177 a <br />Notary Public-Callfarnia <br />". <br />LOS ANGELES COUNTY u <br />My Comm. Expires Oat. 29, P016 <br />