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CITY Or SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6468 <br />SEVENTEENTH STREET WATER MAIN IMPROVEMENITS PHASE 2 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />Regianld Kawale Kama IV being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is n member of the co-partnersbip firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for are copartnership by: <br />who constitute the other members of the copartnership. <br />j3] CORPORATION That he is of <br />AMPCO Contracting, Inc.p <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 bebalf of ate <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 imself or any other person. <br />Sign ire of Bidder <br />Subscribed and sworn to before me this 28th day of June 2017 <br />Signature of officer Adtninistering Oath (Notary Public) <br />P-7 of P-17 <br />23A-11 <br />