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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 15 -6840: WARNER AVENUE PAVEMENT MAINTENANCE <br />PROJECT NO, 16- 6858: FIRST STREET PAVEMENT MAINTENANCE <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he /she <br />and all his/her subcontractors are registered with the State of California Department of Industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: LAM F t\�n scree l`r � tk�25s In <br />Business E-Mail Address: <br />Telephone: <br />State Contractor's License No. and Class: -1t� <br />License Expiration Date: 2A \% <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: l� '1 <br />9 � \ <br />Signed: ..��`�" <br />P -5 of P -17 <br />23A -13 <br />