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MYERS AND SONS HI-WAY SAFETY, INC
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MYERS AND SONS HI-WAY SAFETY, INC
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Last modified
1/8/2018 4:15:59 PM
Creation date
7/17/2017 3:08:31 PM
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Contracts
Company Name
MYERS AND SONS HI-WAY SAFETY, INC
Contract #
15-6833
Agency
Public Works
Council Approval Date
4/4/2017
Insurance Exp Date
9/10/2020
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CERTIFICATE OF ACKNOWLEDGMENT <br />State of California <br />County of San Bernardino <br />On February 6, 2017 <br />before me, Barbara E. Paluzzl, Notary Public <br />(Here insert name <br />personally appeared Mike Rodgers, President <br />who proved to me on the basis of satisfactory evidence to be thepersons) whose name Is subscribed to <br />the within instrument and acknowledged to me that ee tl executed the same in Is, their• authorized <br />capacity(i€s); and that by is ' signature(s) on the instrument the person(o, or the entity upon behalf of <br />which the person(s) acted, executed the instrument. <br />I certify tinder PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph <br />is true and correct. BARBARA E. PALUZZi <br />_ <br />COMM.#2130068 -I <br />U•- ,• NOTARY PUSLIC-CALIFORNIA:-1 <br />�' F� SAN SERNARD(NOCOUNTY C) <br />&ITBSSmy hand and ial seal, M Oc6nruofneoPe"a <br />of A entry ublic (Notary Seal) <br />ADDITIONAL OPTIONAL INFORMATION <br />DESCRIPTION OF THE ATTACHED DOCUMENT <br />(Title or description of attached document) <br />Title or description continued <br />(Title or description of attached document continued) <br />Number of Pages Document Date 4/22/16 <br />(Additional information) <br />CAPACITY CLAIMED BY THE SIGNER <br />❑ Individual (s) <br />❑ Corporate Officer <br />❑ Partner(s) <br />❑ Attorney -in -Fact <br />❑ Tntstee(s) <br />❑ Other <br />Id information checked <br />2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.conr <br />INSTRUCTIONS FOR COMPLETING THIS FORM <br />Any acknowledgment completed in California most contain verbiage exactly us <br />appears above in the notary section or a separate acknowledgment form natst be <br />property completed and attached to that document. The only exception is if a <br />document is to be recorded outside of California. In such instances, any alternative <br />acknowledgment verbiage as may be printed on such a document so long as the <br />verbiage does not require the notary to do something that is illegal for a notary in <br />California (i.e. cerdfying the authorized capacity of the signer). Please check the <br />document carefilly for proper notarial wording and attach this farm ifrequired. <br />• 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 ba the date that the signer(s) personally appeared which <br />must also be the same date the acknowledgtueut is completed. <br />• The notary public must print his or her name as it appears within his or her <br />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 />• Indicate the correct singular or plural forms by crossing off incorrect forms (te. <br />be/she/tlaeyr is /are ) or circling the correct forms. Failure to correctly indicate this <br />information may lead to rejection of document recording. <br />• The notary seal impression must be clear and photographically reproducible. <br />Impression must not cover text or lines. If seal impression smudges, re -seal if a <br />sufficient area permits, otherwise complete a different acknowledgment form. <br />• Signature of the notary public must match the signature on file with the office of <br />the county clerk. <br />Additional information is not required but could help to ensure this <br />acknowledgment is not misused or attached to a different document. <br />Indicate title or type of attached document, number of pages and date. <br />Indicate the capacity claimed by the sic or. If the claimed capacity is a <br />corporate officer, indicate the title (i.e. CBO, CPC, Seensary). <br />• Securely attach this document to the signed document <br />
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