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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-7538 <br />SANTA ANA REGIONAL TRANSPORTATION CENTER <br />RESTROOM RENOVATION <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE ) SS: <br />CITY OF SANTA ANA <br />_I��vt Yeim d� 'terxlg -,being 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 the co -partnership by: <br />who constitute the other members of the co -partnership. <br />CORPORATION That he is of: // <br />�z �Yt�' .V:�r <br />�'rsMu. y rSC.+�r crCJr <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 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 pen iynedol,collusive or sham, and has not in any manner sought by <br />collusi to secure any iray <br />gainst the City of Santa Ana or any person interested in the <br />p ed -contract, for hiy other person. <br />Signature of <br />Subscribed and sworn to before me this <br />Signature of officer <br />P-6 of P-16 <br />20 <br />