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CITE' OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6882 <br />LOCAs. STREET SLURRY SEAL 2016-17 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA ANA <br />) <br />D.ua F.,d <br />, being duly sworn, deposes and says: <br />❑ INDIVIDUAL <br />That helshe is the party making the foregoing proposal: <br />❑ PARTNERSHIP <br />That he/she is a member ofthe co -partnership firm designated as: <br />and who has been and is duly vested with the authority to snake and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />XCORPORATION <br />That he is of: <br />Pavement cedogs ca. -- <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That 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 behalf of the <br />patties 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 />propos ontr ct, for himself or any other person. <br />Signature of Bider <br />Subscribed and sworn to before me this day of 20 <br />Signature of officer Administering Oath (Notary Public) <br />P-6 of P-16 <br />23B-13 <br />