Laserfiche WebLink
EXHIBIT 12 (cont.) <br />4. Efforts made to assist W /MBE in obtaining bonding, lines of credit or insurance, and any technical assistance <br />related to the plans, specifications and requirements for the work which was provided to W/MBE: <br />None <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with W /MBE assistance <br />agencies: <br />I declare under penalty ofperjury Mai the foregoing information is true and correct to the best of my knowledge: I <br />understand that the City of Santa Ana and/or the U.S. Deparlment of Housing and Urban Development may verify <br />the information provided herein in connection with W /MBE compliance evaluationlaudit activities and that faihure <br />to fully and truthfully complete this form may result in economic or other sanctions. <br />Signature: <br />A4 al& <br />Name: <br />Diana Lehm n <br />Title: <br />Office M r <br />Date: <br />1 <br />Name of Contractor /Subcontractor: <br />LEHMAN CONSTRUCTION, INC. <br />Contractor /Subcontractor identification <br />Number: <br />CSLB License 239570 <br />Address (Street, City, State, Zip): <br />1691 Sierra Alta Drive <br />Santa Ana, CA 92705 <br />Business Racial /Ethnic /Gender Code: <br />Circle the numeric code which indicates the racial /ohmic /gender character of the owners) and controller(s) of 51% <br />of the business. When 51% or more is net owned and controlled by any single racial /ethnicity /gender category, <br />circle the code which seems most appropriate. <br />1= White Americans <br />2 = Black Americans <br />3 = Native Americans <br />Woman Owned Business: <br />Circle One: <br />Xes or <br />4 =Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = Hasidic Jews <br />F: 1o0CS\ PROPSVCSIHUDFORMSIMBUBBD4AMB- %cflonMpap 000 23A-36 <br />