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CITY OIL SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6468 <br />SEVENTEENTH STREET WATER MAIN IMPROVEMENTS PHASE 2 <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: AMPCO Contracting, Inc. <br />Business Address: 1540 S. Lewis Street Anaheim, CA. 92805 <br />Business E-Mail Address: mmutton@amycocontracting.com <br />Telephone: 949 -955 -225 5 <br />State Contractor's License No, and Class: <br />851752 A,B,C-21, ASB & HAZ <br />License Expiration Date: December 31 <br />2018 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />1000011759 <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: <br />June 30, 2018 <br />Signed: <br />Title: Reginald Kawale Kama IV- President <br />P-5 ofP-17 <br />