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23B - PROJ - BICYCLE BLVDS
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11/15/2016
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23B - PROJ - BICYCLE BLVDS
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Entry Properties
Last modified
11/10/2016 3:51:23 PM
Creation date
11/10/2016 3:43:35 PM
Metadata
Fields
Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
11/15/2016
Destruction Year
2021
Document Relationships
EXCEL PAVING COMPANY
(Amended By)
Path:
\Contracts / Agreements\ PROJECTS
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CAUFORM/t ALL-PURPOSE ACKNOWLEDGMENT CML CODE § 1189 <br />[F:A;Fr,�Dt==wy ublic or other offm aNTIMP19 this oerdfigte verifies only the Ida * of the InSw dual who signed the to which this moricate is alta w, and not the truthfulness soauracy, or valwityof dra docturmt. <br />State of California <br />County of Los Angeles <br />On-2-!; <br />na)I; it, 2Qi _ -before Me, C. Phillips, Notary Public <br />Date Here Insert Name and Me of Vie Officer <br />personally appeared C. P. Brown _ <br />Names) of Signer(s) <br />who proved to me on the basis of satisfactory evidence. to be the person(s) whose names; Islam <br />subscribed to the within Instrument and acknowledgedto me that halsba ey executed the same in <br />hist authorized capacity(les), and that by hisAttabuir signature(s) on the instrument the person(s), <br />or the entity flptln behalf of which the person(s) acted, executed the Instrument, <br />C. PIiILLlPS <br />COMM. tlF_l.J5Gl1i <br />iS,��•' Not+]ry Pulfllc C.alifpmia p, <br />..t� L052NGEL[:5 COUNTY <br />My Comm. L'xBueq Oct29, 291GiS <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 . <br />(A <br />119 <br />a re of Notary Public <br />Place Notary Seal Above <br />OP77ONAL <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:.., Signers) Other Than Named Above: — _ ____ <br />CapacMes) Claimed by Signer(s)' <br />Signer's Name: <br />❑ Corporate Officer - Trties): <br />❑ Partner - Gl Limited © General <br />❑ Individual ❑ Attorney in Fact <br />• Trustee ❑ Guardian or Conservator <br />n Other. <br />Signer Is Representing <br />Signer's.Name: <br />O Corporate Officer - Tftle(s): <br />© Partner - ❑ Limned ❑ General <br />• Individual 0 Attomey in Fact <br />Cl Trustee ❑ Guardian or Conservator <br />• Other: <br />Signer is Representing: <br />a(_ ..Y'P!..,/:-e•:i.: ,. <br />....... <br />.5 f f'0000,400 <br />un•0:.1'00'00 . 01* <br />m-iy.n <br />23B-20 <br />
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