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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.:] 5-6831 <br />CROSSWALK IJPGIR_ADES - PHASL I <br />FEDERAL PROJECT NO: HS1PL5063(155) <br />OWNERSHIP AFFIDAVIT <br />S"]'AI It 01- UAHI ORNIA l <br />IN I Y OI + *7,`rN -1N. ifBK A,..g,eE d Ss: <br />C'11YOI'cnwrrn nein (,iO+�PTor..i i <br />Iicing duly sworn. del) uses and says: <br />❑INDIVIDUAL, 'lltalhe/she is the part-\ making the foregoing proposal: <br />[J PAR I NFRSI IIP That he/she is a member of the cu-parmcrship firm designated as: <br />and who has been and is duly Nested with the authority to snake and executc instruments <br />I'm r the co -partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of: <br />a corporation which is making the foregoing proposal: <br />❑ JOIN'h VIM URE That lie is of: <br />one of the patties making the foregoing proposal as a joint venime. and the he/she has <br />been laid is duly vested with the authority to execute insttwnents for all on behalf of the <br />parlies 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 securq any advantage against the City of Santa Ana or any person interested in the <br />proposed coiA,actA Ifor himself or any other person. <br />u <br />Subscribed an s7woorrn toobbe_fore roe this 0 day oi- APIZ i1- 20 <_�7 <br />Signature of officer Administering Oath (Notary Public) <br />ROLDA. U7pMAKiL1 <br />ca�nM.a2o,s,as Notarial Certificate <br />NFNOLTARYUBLIC•CALIFORNIAAtt�6s9 i��•JGELES COUNTY ^� dCxp. MAY 9, 2017 <br />P-8 of P-40 <br />