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CITY OF SANTA ,TTA <br />PROPOSAL <br />PROJECT NO.:I 5-6831 <br />CROSSWALK UPGRADES - PRASE I <br />1°EDERAI, PRO.TECTNO: HSIPL 5063(155) <br />OWNERSHIP AFFIDAVIT <br />s'IWIF Of C'AUhORNIA 1 <br />C'O.IJN I Y OP-HR;tidF'rl4 65 <br />UITY OF ,bAA'-4�-,aA7A,.00, PTO' -1 1 <br />being cluly sworn, deposes and sap's: <br />❑ININVIDUAI. That he/she is the puny making the livegoing proposal: <br />PARTNIFRSI IIP 'That he/she is a meiuber ul'the co -partnership frm desiguated as: <br />and who has been and is duly vested with the authority to tttake and execute instrumerns <br />forthe co-pan9ncrship by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of: <br />a corporation which is makingtile foregoing proposal: <br />[] JOINT VENTIJRH: That he Is of: - <br />one of the parties malting 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 malting sapid bid who are: <br />that such a bid is genuine and not collusive or sham, and has not in any maturer sought by <br />collusion to securg any advantage against the City of Santa Ana or any person interested in the <br />proposed con)•jetA Ifor himself or any other person. <br />1 o <br />Subscribed an sworn to before e this day _ _ y f f J 2p �� <br />m <br />Signature of'officer Administering Oath (Notary Public) <br />MA 0 A 'L <br />COMM .#901 5 � NotarialOertif1Cate <br />"LOSANGE�ESCOUNTY Attached <br />Comm. Exp. MAY 9, 2017 <br />P-8 of P-40 <br />