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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17.7522 AND 15-6836 <br />RESIDENTIAL STREET REPAIR PROGRAM <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA ) <br />pp1� (1 <br />being duly sworn, deposes and says: <br />❑ INDIVIDUAL That he%hais 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 />XCORPORATIONThat he is of <br />Diel (th(-,rcik 71 "ec o f)i-no <br />g <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE That he is of <br />one of the parties making the foregoing proposal as ajoint 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 nd sworn to before me thi& da of 2017 <br />Signatur of officer A'ministering Oath (Not ary`Public)ee <br />P-6 of P-16 <br />