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20B - AA - BIKE LANES CHESTNUT
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05/02/2017
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20B - AA - BIKE LANES CHESTNUT
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Last modified
4/27/2017 3:34:39 PM
Creation date
4/27/2017 3:10:04 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
20B
Date
5/2/2017
Destruction Year
2022
Document Relationships
CAL-STRIPE INC.
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Path:
\Contracts / Agreements\ PROJECTS
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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17 -6611 <br />CHESTNUT AVE & BUSH /CYPRESS BIKE LANES <br />FAIDM U58DP005861 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUN'T'Y OF ORANGE I SS: <br />�CITY OF SANTA A,yNA J <br />• 4n�.+ . being only mvoru, deposes and says: <br />❑ INDIVIDUAL Thai be /she is the party making the foregoing proposal: <br />[]PARTNERSHIP That he /she is a member of the co- partnership Finn designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the co- parnership by: <br />who constitute the other members of the co- parnnership. � -- <br />ORPORATION That be is of: <br />a coglointion which is making the foregoing proposal: <br />❑ IOINT VENTURE Thai he is of <br />one of the parties making the foregoing proposal as a ,joint venture, and the he /she has <br />been and is duly vested with the authority to execute instruments for an on behall'of the <br />parties making said hid who are: <br />that such a bird is genuine and not collusive or chain, and has not in any planner sought by <br />collusion to secure any advantage against the City of Santa Ana or any person interested in the <br />proposed contract, for himself or any other person. <br />C'_7 - �__ <br />Signature of Bidder <br />Subscribed and sworn to before file this _ day of Q <br />Oath (Notary Public) <br />A 00181, p1 aLC or other olOCer Mm010pny 10u WOrIRatP, veuL9 §only lira <br />ItlBrilily OY a16111 rtIV10lINl mmS'9riW fhb f10LUn100110 W thr''000'.R, B911 ®ChUtl. <br />xntl nVl lire inflhYUlness acctm, or aha ty of that 0acunrnnl <br />State of California. countyof,55AAwa IMLbUA Wood <br />Subscribed and sworn to (w- afamatil) before me on tma , n <br />day <br />of_MAk.t`1•f +9611 .by...S� FL1 CT?6� <br />proved b me on the basis of satisfactory evidence to be the <br />persori who appeared before me <br />Signptur � _iseai) <br />P -7 of P-39 <br />20B -15 <br />'^ f.KiRRAtlNE MANZANARES <br />Comm.12151dp9 �, <br />m 1► NotayrPyplic =Californllen <br />Sstt iRrftErdlnm Cou nty-° <br />Comine, Egdres May 27, 3020 <br />
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