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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 lie/she <br />and all Itis/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 Naive: <br />Business Address:,. `} <br />Business E -Mail Address.�,� <br />Telephone: <br />State Contractor's License No. and Class: <br />License Expiration Date: <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />a <br />Signed: <br />Title: <br />PW5 of P-17 <br />