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Last modified
6/5/2024 10:17:50 AM
Creation date
7/10/2019 12:24:18 PM
Metadata
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Template:
Contracts
Company Name
T.E. ROBERTS INC.
Contract #
P 11-6413
Agency
Public Works
Council Approval Date
4/2/2019
Notes
Project
Document Relationships
23A - PROJ - SA-5 VAULT MOD
(Attachment)
Path:
\Agenda Packets / Staff Reports\City Council (2004 - Present)\2019\04/02/2019
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CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 <br />ee Attached Document (Notary to cross out lines 1-6 below) <br />Statement Below (Lines 1-6 to be completed only by document signeds), not Notary) <br />2 <br />. .. ___.._.__ <br />Signature of Document Signer No. 1 Signature of Document Signer No, 2 Of any) <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. " <br />State of California <br />County of <br />KIM E. NEWETT <br />COMM, #2228431 zz <br />a ^na a Notary Public • California n <br />z r Orange County <br />M Comm. Expires Feb, 7, 20 U <br />Subscribed <br />)I and sworn to (or affirmed) before me <br />on this _..,.[gLhday of ,_, 20� <br />by Date � _ Year <br />(1)ln <br />(and (2) ), <br />Nome(s) of Signer(s) <br />proved to me on the basis of satisfactory evidence <br />to be the person(s) who appeared before me. <br />Signature ,I A f —AA Lydaj <br />Signature of Notary Public <br />Seal <br />Place Notary Seal Above <br />OPTIONAL <br />Though this section is optional, 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: _ ---Document Date: <br />Number of Pages: _ Signer(s) Other Than Named Above: <br />02014 National Notary Association • www.Nationa[Notary.org • 1-800-US NOTARY (1- O0-676 827) Item #681 q <br />U <br />.I <br />
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