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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6891, 16-6865, 15-6842 <br />ALLEY IMPROVEMENTS <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA <br />COUNTY OF:1�e-os 4.h : n <br />CITY OF Ste.=nrA :'z, � drd"' u kl Cc+Jy`-.- <br />H0. r -y Joh , being duly swom, deposes and says: <br />❑ INDIVIDUAL <br />That he/she is the party making the foregoing proposal: <br />❑ PARTNERSHIP <br />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 />CORPORATION <br />That heThat he�e 7 i d e'At 1 <br />a corporation which is making the foregoing proposal: <br />❑ JOINT VENTURE <br />That he is of <br />one of the parties making the foregoing proposal as a joint 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 and sworn to before me this 28TH day of JUNE 2017 <br />hYi'A 1YJ7' -e Vii; t4' 1-t C-- <br />Signature of officer Administering Oath (Notary Pu lic) <br />uAAAkA A <br />Dale lung <br />Comm. #3106343 `� <br />Nolary PuWk-.California .'. <br />las Angeles Counly <br />Caron. expires Apr. 10, 2019. <br />P-6 of P-16 <br />