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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17 -6611 <br />CHESTNUT AVE & BUSH /CYPRESS BIKE LANES <br />FAID #: IJ58DPOO5861 <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: <br />Business E -Mail Address: <br />Telephone: <br />State Contractor's License No. and Class: (M j!6_4 <br />License Expiration Date: f <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: A ocrco \\ <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />Signed: —_ _. -- <br />Title: <br />P -5 of P -39 <br />20B -13 <br />