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ROBERTI'S INSURANCE (2) - 2013
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ROBERTI'S INSURANCE (2) - 2013
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Last modified
9/30/2013 12:29:27 PM
Creation date
9/30/2013 9:42:26 AM
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Contracts
Company Name
ROBERTI'S INSURANCE
Contract #
A-2013-054
Agency
PUBLIC WORKS
Council Approval Date
4/15/2013
Destruction Year
0
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CALIFORNIA ALL-PURPOSE <br />STATE OF CALIFORNIA ) <br />COUNTY OF Q ) <br />On 20 <br />, before me, r /??. Neo+ r? , <br />Date __ <br />Name And Tnle Of Offim (a.B!'Jana D , Notary Public') <br />personally appeared O <br /> Nam of Slgmx(s) <br /> who proved to me on the basis of satisfactory evidence to <br /> be the person(s) whose name(s) is/are subscribed to the <br /> within instrument and acknowledged to me that he/she/they <br /> executed the same in his/her/their authorized capacity(ies), <br /> and that by his/her/their signature(s) on the instrument the <br /> person(s), or the entity upon behalf of which the person(s) <br /> acted, executed the instrument.. <br />PATRICK C. RAY <br />Commission # 1982973 I certify that under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph is true <br />a ,?+d Notary Public • California <br />z Orange County and correct. <br />My Comm. Ex Tres Jun 23, 2018 <br /> WITNESS my hand and official Seal. <br /> Signature <br />"`o ureeoof NDiary Public <br /> OPTIONAL <br />Though the data below is of required by law, it may prove valuable to persons, relying on the document <br />at id could prevent fraudulent reattachment of this form' <br />Description of Attached Document <br />Title or Type of Document: <br />Document Date: Number of Pages: <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br /> <br />Signer's Name: Signer's Name: <br />? Individual ? Individual <br />? Corporate Officer - Title(s): ? Corporate Officer - Title(s): <br />? Partner- ? Limited 1 1 General ? Partner- ? Limited ? General <br />? Attorney In Fact ? Attorney In Fact <br />? Trustee ? Trustee <br />? Guardian or Conservator ? Guardian or Conservator <br />? Other: ? Other: <br />Signer is representing: Signer is representing: <br /> <br />
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