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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-2648 SANDPOINTE PASEO SECURITY LIGHTING PROJECT <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />) <br />COUNTY OF ORANGE <br />) SS: <br />CITY OF SANTA ANA <br />) <br />s/4n1 N 6m%jeIN) <br />, being duly sworn, deposes and says: <br />❑ 1NDIVIDUAL <br />Thal he/she is the party nicking the foregoing proposal: <br />❑ PARTNERSHIP <br />That he/she is a member of the co -partnership firm designated as: <br />and who has been and is duly Nested with the authority to mnke and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the copartnership. <br />Fi�CORPORATION <br />That he is of: President <br />QAt,ffvO.NiA ppoyezylsr�t'r-rrsi-ry�iNc�,iwc <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That he is of: <br />one of the panics making die 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 ranking 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 c\ontr�U or hil ts�lf or any other person. <br />Signature <br />Subscribed and sworn to bkfore me this 14 day of nwveriA.P,� 2011_ <br />Signature of officer Administering Oath (Notary Public) <br />PLCASE 56E A -c c}tt;D <br />zddflt <br />