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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17-6611 <br />CHESTNUT AVE & BUSH/CYPRESS BIKE LANES <br />FAID#: U58DP005861 <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 (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: <br />Business E -Mail Address: <br />Telephone: q(qr <br />State Contractor's License No. and Class: 6W�256_4 <br />License Expiration Date: 11-51 I`aork�) <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: 1 00cco \N ©® <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: �w <br />Signed: 19, <br />Title: <br />P-5 of P-39 <br />