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12/06/2016
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23C - PROJ - WASHINGTON ELEMENTARY
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Last modified
12/1/2016 4:06:04 PM
Creation date
12/1/2016 3:52:25 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23C
Date
12/6/2016
Destruction Year
2021
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State of California <br />County or_Los Arigeles <br />Iss, <br />Subscribed and sr ae m <br />worn to ((or before on this .,-10_—_ day of October 20 16 , by <br />Van Nguyeyi <br />proved to me on the basis of'satisfactory evidence <br />to be the person(x� who appeared before me. <br />MAARY SSIGNATURI, <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. 8ccuracv, or validity of that document. <br />PLACH NO r,"ZY ihAl- N AUOVI; SV',%CF <br />OPTIONAL INFORMATION <br />The information below is optional. However, it may prove valuable and could prevent fraudulent attachment <br />or this form to on unauthorized document. <br />CAPACITY CLAIMED BY SIGNER (PRINCIPAL) DESCRIPTION OFATTACHED DOCUMENT <br />E] INDIVIDUAL <br />Kx] C010'ORAI-OFFICER b.--osi�a�.9N.=Iy,-Tfcasurer,Manager TITLE ORTYPE OF DOCURIHN'T <br />[,- I PARTNr -,R(S) <br />r] NITOR N LY-IN-VACT <br />Ei TRUSTEE(S) NUMBER OF'I'AGIN <br />G[JAIiDIANI(-'ONST-�,IZVYVI'01,' <br />OTHER: <br />)AM'OF )CUN4F.N1 <br />(YFflFR <br />A BSENTSI G N ER (PRINCIPAL) IS REPRF-SENT1 NG: <br />[UGH r <br />NAME OFITRSON(S) OR FNI 11 MM T11UMBPRINT <br />Califoinia Proficssimal Engineering, hic, OF <br />SIGNER <br />r. <br />41 4 , IF, <br />23C-43 <br />
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