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Last modified
10/23/2018 9:22:43 AM
Creation date
4/3/2017 12:48:05 PM
Metadata
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Template:
Contracts
Company Name
GOLDEN STATE CONSTRUCTOR
Contract #
16-2671
Agency
Public Works
Council Approval Date
2/7/2017
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CALIFORNIA ALL- PURPOSE <br />CERTIFICATE OF ACKNOWLEDGMENT <br />A notary public or other officer completing this certificate verifies only the Identity <br />of the individual who signed the document to which this certificate is attached, <br />and not the truthfulness, accuracy., or validity of that document. <br />Mate of California <br />County of Orange <br />Cin before mer Claudia Cochran, Notary Public <br />knoremso mi-A-10-amd mi—A-10—amRib of the o iter <br />personally appeared ���. Ron i fir _ <br />who proved to me onthebasis of satisfactory evidence to be the person(owhose <br />name(a) Is1 subscribed to the within Instrument and acknowledged to me that <br />he/ ieMey-exocuted the same In his/he4"- authorized capacltyk4Q, and that by <br />h1s4re4hetix slgnature(f) on the instrument the person(4 or the entity upon behalf of <br />which the person(s) acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under the laws of the Mate of California that <br />the foregoing paragraph is true and correct. _ CLAUDIA C.�HA-j <br />t ,, JCOMM # 2096862 <br />WITNESS mil hand d official l. � �`;�� � w ORANGE COUNTY <br />my anosea( T NOTARY PUBLIC -CALIFORNIA Z <br />Q MY COMMISSION EXPWS <br />JAN.3012019 <br />Notary Public Signature (Notary Public Seal) <br />ADDITIONAL OPTIONAL INFORMATIONINSTRUCTIONS FOR COMPUE INC! TI -118 FOXM <br />,fol -lit cnnrpldev tpd;k currant Cegliforala strtttrtes raga -ding rrolary wor'dlug and, <br />0ESC RIP ION OF T'H E ATTACH FD DOCUM )j'rrcrrderl, sltnulelbe rmmple*d and auaalrad to tlie�(rr+:tttrterrt. Aakrrorvled,�rnsrrls <br />frorrr rather stntas may be rorrrplatad r'ar rdewunjams belmg.s'crrt to that state so long <br />asp the tvardhr,ts sloes not require the C'rd(fornia rrolary to violate Calrforrria notwy <br />1mv. <br />{Tit10 oP dtrhorlpl5 o aalioahed document)— State and County inforaindon nrust bo the Starts and County where tho doutrmant <br />si ncr'(s) personally appeared befnrc tine lrotaty publta for acknowlcd.gaimit, <br />-- -- s Bate of notarization must be the d.atc ibut the signor(s) Personally appent'ed whie'll <br />(Tido or dwriplion of attached document vanllnued) must also be the same date the acknowiedgmeot is contpletod, <br />+ T'he uotaty publie roust print his or her name as it UPPears within his or her <br />Number of Pages —Document Date.— commission followed by a comma and Ilrcn your title (notary public), <br />r Print the nine(s) of daatunont sigtrer(s) who pergorrally nppeur at the time of <br />_ _ notarizotictn, <br />CAPACITY ITY CLAIMED BY THE SIGNER . bidicnta Etas rorreat singular or Plural forms by crossing off incorrect forms (i.c. <br />La IndlVldu { � drolshedthoyrIs la+'o ) ar uhcl.inB the corroot fomm Fallure to coriOctiy indiaaho this <br />infnruuttian tray Iced to rejeatIO$1 Of Clocunrcnt reeorcEing, <br />0 Corporate Officer a 'The tiolory goal impregglon must be clunr and photographically repruduciblc, <br />lmprension trust rot cover text or lues. If goal Entpression srrludges, ro-twal if a <br />'""w"'""." KT ---Sufficient ar•au parmitg, othortvise complete a ditki,erit acknowleclsutent form, <br />P II`inHl �B� r Mgrraturc of the notary public must match lire signature, nn file with tiie oil"sec of <br />tho county cltl k. <br />0 Attorney^irl-Fact Additiourtl information is not required btu could help to ennurc this <br />I i ru igt��6� a acicnawlcrclgrrrent is not rnlsused or atltached to a dlffcrent docurru t, <br />Other Indicate title or type of nuvitcd dcrcatuerlt, au.rnber of pagrs and dats, <br />-__...... ___-----_---__- ., v �w Indlaatte the capaoity elainwd by the slgttcr% ff the cirtimod empacify is tir <br />#trd E i "'Un <br />0011)01 Ale ncer, tnciur t ro trt a (tC ".e. , kt7 <br />� <br />, ecrotasy), <br />e Secui Cly attaoh this document to tine sigrrod document with a s aph", <br />
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