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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6891, 16-6865, 15-6842 <br />ALLEY IMPROVEMENTS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA (�,C <br />COUNTY OF �r�' Gof �h�{�rss: <br />CITY OF S,"�mr+ir/ni' vri fe.A Wu11T CE <br />Ha • / Joh -,being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the co -partnership by: <br />® who constitute the other members of the co -partnership. <br />T4CORPORATION That he� j - OY u . T0f_ <br />e i e�� O'r r I Y' (,py�s'pYi� rft <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE 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 />parties 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 />proposed contract, for himself or any other person. <br />Signature of Bidder <br />Subscribed and sworn to before me this 28TH day of JUNE 20 17 <br />SLK;�� yerajJ ,,v�u40LIc- <br />Signature of officer Administering Oath (Notlic) <br />u <br />Comm.#.#a110606 <br />_ 2<3 e <br />Notary Public. California <br />Lot Angeles Cauuy <br />Cant espiret Apr. 10, 2019 <br />P-6 of P-16 <br />23B-12 <br />