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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6572 <br />SAFE ROUTES TO SCHOOL ENHANCEMENTS FOR WASHINGTON ELEMENTARY <br />STATE PROJ ECT NO: ATPL- 5063(161) <br />OWNERSHIP AFFIDAVIT <br />STATE OFCA,IFORNIA ) <br />COON"CY OF ORANGE l SS: <br />CITY OF SANTA ANA ) <br />Van Nguyen being duly stcorn, deposes and says: <br />❑INDIVIDUAL 'that hefshe is lho party making the foregoing proposal: <br />[] <br />PAR INERSI-I1P Thal he/she is a member orthe co -partnership thin designated as: <br />and who has been and is duly vested with the authority to make and execute htsu'untents <br />11m, the co -partnership by: <br />who constitute the other members orthe co-pattnership. <br />EK('0100RATION That he is of., <br />.�C2Sld4'gt-4]f—�`sillf.9llllcl-P CU�G',SSlQCl1.�..F f1.C�LpP.k'CtK1CJ�-Il7.O.- <br />a corporation which is making, the Ibregoing proposal: <br />❑.10IN'I VEN PURE That he is of. <br />one ol'the parties making the tbregoing proposal as n.joint venaum, and the be/she has <br />been and is duly vested with the authority to execute instruments Ibr 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 c ntr c ftZrlut>?self )r any other person. <br />Signature of Nidder <br />Subscribed and sworn to before r�e this clay of 20 <br />Signature of officer Administering Oath (Notary Public) <br />13-7 ofP-17 <br />