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Agmt01 Western States Surfacing
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Agmt01 Western States Surfacing
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Entry Properties
Last modified
7/21/2005 12:24:21 PM
Creation date
5/13/2002 9:59:25 AM
Metadata
Fields
Template:
Agreement
Contractor Name
Western States Surfacing
PROJECT NAME
Asphalt rubber chip seal project
RMP File Number
304
Date
6/25/2001
Reso Ref
14253
MO Ref
01-125
Box
5941
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<br />CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT <br />~~-~~ -------- <br /> <br />----- <br /> <br />County of <br /> <br />placer <br /> <br />} ss. <br /> <br />State of California <br /> <br />On <br /> <br />June 5.2001 <br />Date <br /> <br />, before me, <br /> <br />Judy L. Maxwell, Notary Public <br />Name and Hie of Officec le.g , "Jane Doe, Notar; pubnc") <br /> <br />personally appeared <br /> <br />Marcie E. Thomas <br />Namels) of Signecls) <br /> <br />~ personally known to me <br />[] proved to me on the basis of satisfactory <br />evidence <br /> <br /> <br />JUDY L. MAXWELL <br />COMMISSION 1\11273875 <br />NOTARY PUBLIC - CAI./FOtINIA E <br />SACRAMENTO COUNTY. <br />COMM. UPIRESAUG U, 2~O4 <br /> <br />to be the person(s) whose name(s) is/are <br />subscribed to the within instrument and <br />acknowledged to me that he/she/they executed <br />the same in his/her/their authorized <br />capacity(ies), and that by his/her/their <br />signature(s) on the instrument the person(s), or <br />the entity upon behalf of which the person(s) <br />acted, executed the instrument. <br /> <br />WITNESS my hand and official seal. <br /> <br />Place Notar; Seal Above <br /> <br />~ ~ M."(~u ,,~/ <br />Signatuce of Nojar; pubnc <br /> <br />OPTIONAL <br /> <br />Though the information below is not required by law, it may prove valuable to persons relying on the document <br />and could prevent fraudulent removal and reattachment of this form to another document. <br /> <br />Description of Attached Document <br />Title or Type of Document: GNA Surety General Purpose Rider ¡Bond No. 929170864 <br /> <br />,I <br />I <br />I <br />,I <br /> <br />Document Date: <br /> <br />June 5,2001 <br /> <br />Number of Pages: <br /> <br />One (1) <br /> <br />Signer(s) Other Than Named Above: <br /> <br />1 <br />I' <br /> <br />Capacity(ies) Claimed by Signer <br />Signer's Name: Marcie E. Thomas <br />D Individual <br />D Corporate Officer - Title{s}: <br />D Partner - D Limited D General <br />~ Attorney in Fact <br />D Trustee <br />D Guardian or Conservator <br />D Other: <br /> <br /> <br />. <br />Top of thumb here <br /> <br />Signer Is Representing: National Fire Insurance Company of Hartfor <br /> <br />- - - <br /> <br />- - - - <br /> <br />- - - - <br /> <br />"'999 National No"~A"'oclation '9350 Do SotoAve., P.D. Bo, 2402' Chatsworth, CA91313-24O2 '_.natl,,",I"o"~.ocg <br /> <br />Prod. No. 59O? <br /> <br />Ro'"d,,' Call ToII-F~e I-BOD-8?'-'82? <br />
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