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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-6468 <br />SEVENTEENTH STREET WATER MAIN IMPROVEMENTS PHASE 2 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANOB ) SS: <br />CITY OF SANTA ANA ) <br />Regianld Kawale Kama IV behtg 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 tho co -partnership by: <br />who constitute the other members of the co -partnership. <br />j$] CORPORATION That he is of: <br />AMPCO Contracting, Inc <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 end 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 f``or himself Or any other person. <br />Sig�TreBidder <br />Subscribed and sworn to before me ties 28th day of June 2017 <br />Signature of officer Achninistering Oath (Notary Public) <br />P-7 of P-17 <br />