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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6447 <br />WEST GROVE VALLEY NEIGHBORHOOD WATER MAIN IMPROVEMENTS <br />OWNERSHIP AFFIDAVIT <br />STATE OF QkLIFOR RA WISCONSIN) <br />COUNTY OF 9RANGE DODGE ) SS: <br />CITY OF oAa.'^.A r"c;A BROWNSVILLE) <br />ut4.LG MEL.UE-n — , being duly swom, deposes and says: <br />El INDIVIDUAL That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as: <br />and who has been and is duly vested with the authority to make and execute instruments <br />for the co -partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of. <br />Michels Pipeline Construction a division of Mi h Is Corporation <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of.- <br />one <br />f: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 behalf of the <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 himself or any other person. <br />Signature of Bidder <br />Subscribed and swo to before me this )S-A day of —'Dpmn1 et, 2011 <br />Signature of officer Administering ath (Notary Public)114 <br />tw"sR <br />P-6 ofP-16 <br />20A-12 <br />