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GOLDEN STATE CONSTRUCTOR
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Last modified
7/7/2025 11:56:55 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
Expiration Date
11/3/2017
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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 />State of California <br />County of Orange <br />On I6,I"-1 C <br />before me, Claudia Cochran, Notary Public , <br />JI-lere Insert name an Me'al e officer) <br />personally appeared Ccchw an9 <br />who proved to me on the basis of satisfactory evidence to be the person(*whose <br />name(&) is/*% subscribed to the within instrument and acknowledged to me that <br />hePahe,Alexecuted the same in his/he4*io& authorized capacity{i), and that by <br />his/ tKeir signature(s-) on the instrument the person(4 or the entity upon behalf of <br />which the person(4) acted, executed the instrument. <br />1 certify under PENALTY OF PERJURY under the laws of the State of California that <br />the foregoing paragraph is true and correct. <br />CLAUDIA COCNRAN <br />COMM # 2096862 <br />WITNESS my hand and official seal. z = : ' ORANGE COUNTY <br />w Q ' M NOTARY PUBLIC -CALIFORNIA Z <br />Q MY COMMISSION EXPIRES ~' <br />30. 2019 <br />Notary Public Signature (Notary Public seal) <br />ADDITIONAL OPTIONALINFORMATIONINSTRUCTIONS FOR COMPLETING THIS FORM <br />This form complies with current California statutes regarding notary wording and <br />DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments <br />from other states may be completed for documents being sent to that state so lona; <br />as the wording does not require the C.`alifornia notary to violate Cal{fornia notary <br />law. <br />(Title or description of attached document) • State and County information must be the State and County where the document, <br />signer(s) personally appeared before the notary public for acknowledgment. <br />. Date of notarization must be the date that the signer(s) personally appeared which <br />(Title or description of attached document continued) must also be the same date the acknowledgment is completed. <br />a The notary public must print his or her name as it appears within his or her <br />Number of Pages Document Date commission followed by a comma and then your title (notary public). <br />• Print the name(s) of document signer(s) who personally appear at the time of <br />notarization. <br />CAPACITY CLAIMED BY THE SIGNER a Indicate the correct singular or plural forms by crossing off incorrect forms (Le, <br />lta/shelthe},,- is /ars) or circling the correct forms. Failure to correctly indicate this <br />• Individual (S) information may lead to rejection of document recording. <br />Cl Corporate Officer • The notary seal impression must be clear and photographically reproducible. <br />Impression must not cover text or lines. If seal impression smudges, re -seat if a <br />(Title) sufficient area permits, otherwise complete a different acknowledgment farm. <br />© Partner(s) • Signature of the notary public must match the signature on file with the office of <br />the county clerk. <br />❑ Attorney -In -Fact Additional information is not required but could help to ensure this <br />• TrusteB(s) acknowledgment isnot misused or attached to a different document. <br />*. .Indicate title or type of attached document, number of pages and date. <br />Other •; indicate the capacity claimed by the signer. If the claimed capacity is a <br />corporate officer, indicate the title (i.e. CEO, CFO, Secretary). <br />• Securely attach this document to the signed document with a staple. <br />
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