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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 />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />JAtQ N a ule-l') , being duly sworn, deposes and says: <br />❑ 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 />dCORPORATION That he is of: President <br />OW"N1A PI�'iE�t�sN^r- HNbinrgt'7Ci�50-�iuvC . <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of: <br />one of the parties mating 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 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 adv ntage against the City of Santa Ana or any person interested in the <br />proposed contr/ C or hiijsyllf or any other person. <br />Signature of <br />Subscribed and sworn to Wore me this 14 day of Kovera,veo. 201]_ <br />Signature of officer Administering Oath (Notary Public) <br />?LeASE 515'E A-CrflCH00 <br />P-6 of P-16 <br />