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23A - TRAFFIC SIGNAL MODIFICATION
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04/03/2018
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23A - TRAFFIC SIGNAL MODIFICATION
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Last modified
3/29/2018 7:13:15 PM
Creation date
3/29/2018 6:59:03 PM
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
4/3/2018
Destruction Year
2023
Document Relationships
BELCO ELECTRIC, INC.
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Path:
\Contracts / Agreements\ PROJECTS
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ALL- PURPOSE <br />CERTIFICATE OF ACKNOWLEDGMENT <br />A notary public or other officer completing this certificate verifies only the <br />identity of the individual who signed the document to which this certificate <br />is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California } <br />County of San Bernardino } <br />Ort iUVOt/l/ 22 2Q before me, Olivia Chea, Notary Public <br />en,neea name an eel Ne oNeo m�� <br />personally appeared John Wong <br />who proved to me on the basis of satisfactory evidence to be the person(s) whose <br />name(s) Is re subscribed to the within instrument and acknowledged to me that <br />(Qshe/they executed the same in jUs er/their authorized capacity(iss), and that by <br />Is er/their signature(s) on the instrument the person(s), 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 State of California that <br />the foregoing paragraph is true and correct. <br />�T q:... <br />Mmy ha d and official seal. i•",e i ac.. OLIVIA CHEA Commission No. 2107474 <br />NOTARY PUBLIC -CALIFORNIA <br />SAN BERNARDINO COUNTY <br />r' My Comm. Expires APRIL 18. 2019 <br />................. <br />ary PubIc signature (Notary Public Seal) <br />ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM <br />DESCRIPTION OFTHEATTACHEDDOCUMENT Th,—tocomplies with current Californiastatutes regarding notarywording and. <br />iifneeded, should be completed and atrachedlo the document. AcMohredgents from <br />other states may be co npletedfor documents beingsent to that state so long as the <br />u wording does not require the California notary to violate California notary law. <br />(rifle or desaipdcrl of attached document) • State and County information must be the State and County where the document <br />sign r(s) personally appeared before the notary public for acknowledgment <br />• Dale of notarization must be the date that the signer(s) personally appeared which <br />(Title ordescrip6m of attached document continued) must also be the same date the acknowledgment is completed. <br />• 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 signers) who personally appear at the time of <br />notarization. <br />CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect fortes (i.e. <br />❑ Individual (s) helshehkey, is tare) or circling the correct forms. Failure Incorrectly indicate this <br />information may lead to rejection of document recording. <br />I] Corporate Officer • The notary seal impression must be clear and phulogmphically reproducible. <br />Vice President Impression must not cover text or lines If seal impression smudges• re -seal if a <br />(Title) sufficient area permits, otherwise complete a different acknowledgment form. <br />❑ Partner(s) • Signature of the notary public must match the signature on file with the office of <br />the county clerk. <br />❑ Attomey-in-Fact 8 Additional information is not required but could help to ensure this <br />❑ Trustee(s) acknowledgment is not misused or attached to a different document. <br />Other v Indicate title or type of attached document. number ol'pages and date. <br />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 />2015 Ver,,,, IN Securely attach this document to the signed document with a staple. <br />23A-14 <br />
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