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Last modified
6/14/2016 2:50:58 PM
Creation date
6/14/2016 1:14:06 PM
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Template:
Contracts
Company Name
TAKAI, LLC.
Contract #
A-2016-123
Agency
PUBLIC WORKS
Council Approval Date
5/17/2016
Destruction Year
0
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CALIFORNIA ALL-PURPOSE 1. 'J ODE § 1189 <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 04ir• ) <br />On .-)i.w-\e 1(]i "7�)(L, before me, Z)�A 6. R yfS HAf� {�''k_66L, <br />Date Here Insert Name and Title of the Officer <br />personally appeared DC,6A <br />Name(s) of Signer(s) <br />who proved to me on the basis of satisfactory evidence to be the personK whose name( is/are <br />subscribed to the within instrument and acknowledged to me that he /ehe/*ey executed the same in <br />his /her their- authorized capacity(j*, and that by his/her/their signature(a)on the instrument the person, a), <br />or the entity upon behalf of which the persorl(s) acted, executed the instrument. <br />ROSA A.FLORES <br />+ Commission # 2057929 <br />Notary Public • California a <br />Orange County <br />NI Comm. Expires Feb 7,.2018 <br />Place Notary Seal Above <br />I certify under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph <br />is true and correct. <br />WITNESS my hand and official seal. <br />Signature l°- L& <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 Affiached Document <br />Title or Type of Document: <br />Number of Pages: <br />Document Date: <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 />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />©2014 National Notary Association ° www.NationaiNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5907 <br />
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