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Last modified
12/11/2018 9:04:05 AM
Creation date
12/11/2018 8:57:10 AM
Metadata
Fields
Template:
Contracts
Company Name
CEM CONSTRUCTION CORPORATION
Contract #
16-6862
Agency
Public Works
Council Approval Date
10/2/2018
Document Relationships
23A - PROJ - CABRILLO PARK SIDEWALK
(Attachment)
Path:
\Agenda Packets / Staff Reports\City Council (2004 - Present)\2018\10/02/2018
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br />CIVIL CODE § 1189 <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document <br />to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California pp <br />County of Los iny (k,I <br />' ,.s j t- <br />On jO w-% ri1Cjg before me, �(rkogj� &'I 0h <br />Date 11 re Insert Name and Title of the Officer' <br />personally appeared <br />S'u s R <br />Name(s) of Signer(s) <br />who proved to me on the basis of satisfactory evidence to be the person(sj whose name(a) is/are-subscribed <br />to the within instrument and acknowledged to me that he/she;6they executed the same in hishyal;1their <br />authorized capacity(ies), and that by his/h2ttheir signatures) on the instrument the person(sr-or the entity <br />upon behalf of which the person(s) acted, executed the instrument. <br />IANGMANOH <br />...i5 Notary Public -California <br />Los Angeles County <br />*Commission # 2242935 <br />My Comm. Expires Jun 14, 2022 J <br />Place Notary Seal and/or Stamp Above <br />I certify under PENALTY OF PERJURY under the <br />laws of the State of California that the foregoing <br />paragraph is true and correct. <br />WITNESS my hand and official seal. <br />Signature <br />Signature of Notary Public <br />Completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: <br />Document Date: t® Z 7(—)—/ <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer - Title(s): <br />❑ Partner - ❑ Limited ❑ General <br />&ia4 <br />of Pages: I <br />Signer's Name: <br />❑ Corporate Officer - Title(s): <br />❑ Partner - ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian of Conservator ❑ Trustee ❑ Guardian of Conservator <br />❑ Other: ❑ Other: <br />Signer is Representing: <br />02017 National Notary Association <br />Signer is Representing: <br />
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