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EXHIBIT 12 (cont.) <br />4. Efforts made to assist W/MBE in obtaining bonding, lanes of credit or insurance, and any technical assistance <br />related to the plans, specifications and requirements for the work which was provided to W/MBE: <br />5. Any additional data to support a demonstration of good faith effort, such as contr,3cts with W/MBE assistance <br />agencies: <br />I declare under penalty ofperjury that the foregoing information is true and correct to the best of my knowledge. I <br />understand that the City ofSanta,4na aWlor the US. Department of Housing and Urban Development may verify <br />the information provided hereini.n co cti n with WIMBE compliance evaluation/audit activities and that failure <br />fo filly and truthfully comp i'his f resultin economic or other sanctions. <br />Si uature: <br />Klassie Engineering & Construction Inc. <br />Name:--- <br />Keivan Shit li�� <br />Title: <br />C.E.O. <br />Date: <br />Name of contractor/Satbcoantraetor: <br />Klassie Engineering & Construction Inc. <br />Contractor/Subcontractor Identification�� <br />Number: <br />042098769 <br />Address (Street, city, <br />250 S. Tustin St. <br />Orange, Ca, 92866 <br />Business Racial/Ethnic/Gender Code: <br />Chicle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% <br />of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, <br />circle the code which seems most appropriate. <br />1 = White Americans <br />2 — Black Americans <br />3 =Native Americans <br />Woman Owned Business: <br />Circle One: <br />Yes 1 0 <br />4 = Hispanic Americans <br />5 = Asian/Pacific Americans <br />6 = Hasidic Jews <br />No <br />F.\DOCS\PROPSVCS\HUDFORMS\MBU56U4AM0 - Sectlon35pecs. DOC <br />