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EXHIBIT 12 (cont.) <br />4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any technical assistance <br />related to the plans, 'specifications and requirements for the work which was provided.to W/MBE: <br />5. Any additional data to support a demonstration of good faith effort, such as contracts with Ru/MBE assistance <br />agencies: <br />I declare under penalty ofperjury that the foregoing information is trite artd correct to the hest, of my knowledge. I <br />understand that the City of Santa dna at /or the U.S. Department of Elousing and Urban Development may verify <br />the information provided hereintin co cti{�n with Y�/MBE compliance evahtatiorr/audit activities and tha(failure <br />to filly and truthfully complete thus] by result in economic or other sanctions. <br />Si nature: 77M, 7 <br />Name: Keivan Shirali <br />Title: C.E.Q. <br />Date. 11/14/17 <br />Name of Contractor/Subcontractor: <br />Klassic Engineering & Construction Inc. <br />Contractor/Subcontractor Identification <br />Number: <br />042098769 <br />Address (Street, City, State, Zip): <br />250 S. Tustin St. <br />Orange, Ca. 92866 <br />Business Racial/Ethnic/Gender Code: <br />Circle the numeric code which indicates the raciaUethnic/gender character of the owner(s) and controller(s) of 51 % <br />of the business. When 51% or more is not owned and controlled by any single. racial/ethnicity/gender category, <br />circle the code which seems most appropriate. <br />I = White Americans 4 = Hispanic Americans <br />2 = Black Americans 5 = Asian/Pacific Americans <br />3 = Native Americans 6 = Hasidic Jews <br />Woman Owned Business: <br />Circle One: <br />Yes or No <br />- F]DOCS%PROPSVCSV UOFORMS%IBUSBNWB. S"EU Spem.00C""'. __ .__. .. ...... ._ __ _._.- <br />23A-47 <br />