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10/01/2019
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20C - AA - STREET LIGHT MAINT
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Last modified
9/26/2019 7:46:41 PM
Creation date
9/27/2019 4:09:08 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
20C
Date
10/1/2019
Destruction Year
2024
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iA11:71rY <br />414�4*e♦1411101P+114* <br />State of California l <br />County of Los Angeles } SS. <br />Subscribed`1 and sworn to (or affirmed) before me on this "I� , day of �, 20—A, by <br />_ \1�T11`r N m u'j , proved to me on the basis of satisfactory evidence <br />to be the person(s) who appeared before me. <br />ALICIA NGUYEN <br />COMM. # 2211346 <br />NOTARYPUilUC -CALIFORNIA <br />LOS ANOELES COUNTY <br />Comm. Ezp. AUG. 25, 2021 <br />NOTARY'SSICNATURE <br />A notary public or other office 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. accuracv. or validitv of that document. <br />PLACE NOTARY SEALINABOVE SPACE <br />OPTIONAL INFORMATION <br />The information below is optional. However, it may prove valuable and could prevent fraudulent attachment <br />of this form to an unauthorized document. <br />1 CAPACITY CLAIMED BY SIGNER (PRINCIPAL) <br />DESCRIPTION OFATTACHED DOCUMENT 1 <br />1 INDIVIDUAL <br />rv(� <br />I2�� <br />ST <br />DO^C�UMENT <br />CORPORATE V� <br />[� PORATE OFFICER r <br />TITLE OR TYPE OF� / <br />/ ❑ PARTNER(S) TITLE(S) <br />1 <br />❑ ATTORNEY -IN -FACT <br />_ I <br />1 TRUSTEE(S) <br />❑ <br />NUMBER OF PAGES 1 <br />❑ GUARDIAN/CONSERVATOR <br />❑ OTHER: <br />DATE OF DOCUMENT p <br />1 <br />! <br />/ <br />OTHER <br />/ <br />1 ABSENT SIGNER (PRINCIPAL) IS REPRESENTING: <br />/ <br />RIGHT <br />NAMEOFPERSON(S)ORENTITY(IES) <br />/ <br />THUMBPRINT <br />1 <br />OF <br />1 <br />1 <br />SIGNER <br />1 <br />/ <br />/ <br />i <br />i <br />1 <br />/ 1 <br />/ 1 <br />i�,rre-�e�.ereoe�eeeeeeeeeeeeer��eee���e���e�+.►���e���e��/ <br />101,2W9 NOTARY BONDS, SUPPLIES AND FORMS ATHTTP://WWW.VALLEY-SIERRA.COM 02005-2W8VALLEY-SIERRA INSURANCE <br />20C-20 <br />
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