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Agmt04 Western States Surfacing
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Agmt04 Western States Surfacing
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Entry Properties
Last modified
7/21/2005 12:24:38 PM
Creation date
8/31/2004 11:44:38 AM
Metadata
Fields
Template:
Agreement
Contractor Name
Western States Surfacing
PROJECT NAME
asphalt rubber chip seal 03-04
RMP File Number
304
Date
8/6/2004
MO Ref
04-121 05-06
Box
5941
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<br />CALIFORNIA ALL-PURPOSE A\ 1.40WLEDGMENT No. 5907 <br />State of California <br />County of Sacramento <br />On July 2, 2004 before me, Melody L. Lumpkin, Notary Public , <br /> DATE NAME, mLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC" <br />personally appeared Thomas R. Hucik , <br /> NAME(S) OF SIGNER(S) <br />[8j personally known to me - OR - 0 proved to me on the basis of satisfactory evidence to be thè person(s) <br /> whose name(s) is/are subscribed to the within instrument and <br /> acknowledged to me that he/she/they executed the same in <br /> his/her/their authorized capacity(ies), and that by his/her/their <br /> signature(s) on the instrument the person(s), or the entity upon <br /> behalf of which the person(s) acted, executed the instrument. <br /> hand and official seal. <br /> SIGNATURE OF NOTARY <br /> OPTIONAL <br />Though the data below is not required by law, it may prove valuable to persons relying on the document and <br />could prevent fraudulent reattachment of this form. <br /> CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT <br />o INDIVIDUAL <br />o CORPORATE OFFICER <br /> TITLE OR TYPE OF DOCUMENT <br /> TrrLE(S) <br />o PARTNER(S) B LIMITED <br /> GENERAL <br />[8j ATTORNEY-IN-FACT <br />D TRUSTEE(S) <br />0 GUARDIAN/CONSERVATOR NUMBER OF PAGES <br />o OTHER: <br />SIGNER IS REPRESENTING: DATE OF DOCUMENT <br />NAME OF PERSON(S) OR ENTITY(IES) <br />Western Surety Company <br /> SIGNER(S) OTHER THAN NAMED ABOVE <br />S-4067fGEEF 2f98 C 1993 NATIONAL NOTARY ASSOCIATION· 8236 RemmetAve., P.O. Box 7184· Canoga Park, CA 91309-7184 <br />.- -, ì -...--..·-...···1---.. . ..- <br />
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