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23A - PROJ - RESIDENTIAL STREET REPAIR
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02/02/2016
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23A - PROJ - RESIDENTIAL STREET REPAIR
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Last modified
1/28/2016 4:29:21 PM
Creation date
1/28/2016 3:18:18 PM
Metadata
Fields
Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
2/2/2016
Destruction Year
2021
Document Relationships
EBS GENERAL ENGINEERING INC.
(Related to)
Path:
\Contracts / Agreements\ PROJECTS
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CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 <br />. rcc, �l> GS'. zreS. tr, tC. cc. c' C-.C;: C) �. ccCCC. ccx: c, 6ccc -.cfctc:t`.rcrsc;rcArrcrxic; rrrcrcrc> cr, CCrcrcxdrercr .LrczC,t:S`.t:C,tresfs;".P.c <br />I I See Attached Document (Notary to cross out lines 1-6 below) <br />IN See Statement Below (Lines 1-6 to be completed only by document signer[s), not Notary) <br />Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if 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 ORANGE <br />LEXIE SHERWOOD <br />COMM. # 2031782 <br />NOTARY PUBLIC +CALIFORNIA .�. <br />0 <br />' Tr <br />ORANGE COUNTY <br />> Comm. Exp. JULY 27, 2017 <br />v-v-v <br />Seal <br />Place Notary Seal Above <br />Subscribed and sworn to (or affirmed) before me <br />on this 17TH day of DECEMBER 20 15 , <br />by Date Month Year <br />(1)__ CHARLES L. FLAKE <br />(and (2)5�_ - = —_ <br />Name(s) of Signers) <br />proved to me on the basis of satisfactory evidence <br />to be the person(s) who appeared before me. <br />Signature 6((Z ZZ Oi�� <br />Signature of Notary Public <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: <br />Number of Pages: -- Signer(s) Other Than Named Above: <br />Document Date: <br />02014 National Notary Association - www.NationalNotary.org - 1- 800 -US NOTARY (1 -800- 876 -6827) Item 65910 <br />23A -23 <br />
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