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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECTNO:: 17-6882 <br />LOCAL STREET SLURRY SEAL 2016-17 <br />OWNERSHIP AFFIDAVIT <br />STATE OF CALIFORNIA ) <br />COUNTY OF ORANGE <br />CITY OF SANTA ANA <br />Doug Foss , 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 isduly 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 />Pavement Coegngs Co. <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 jointventure, 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 />propos outx ct, far himself or any other person, <br />Signature of Bidder <br />Subscribed and sworn to before me this day of 20 <br />Signature of officer Administering Oath (Notary Public) <br />P-6 of P • 16 <br />