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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO,: 17-7522 AND 15-6836 <br />RESIDENTIAL STREET REPAIR PROGRAM <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she <br />and all his/her subcontractors are registered with the State of California Department of Industrial <br />Relations (DTR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E -Mail Address: <br />(oAuO Uqwftnvi.Jj ale ReOm G` eAN <br />Telephone: Ci 0 q — "_� ?) b -- � , a-�) U J <br />State Contractor's License No. and Class: <br />License Expiration Date: <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: (1 O 0 C) o �! x <br />State Dept. of Industrial Relations (DIR) f,, <br />Registration Expiration Date: �/ 1 `,)Q \ g <br />Signed: ISwn ✓� <br />Title: <br />P-4 ofP-16 <br />