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Agmt05 Western States Surfacing
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Agmt05 Western States Surfacing
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Entry Properties
Last modified
12/28/2007 11:38:30 AM
Creation date
9/21/2005 9:22:53 AM
Metadata
Fields
Template:
Agreement
Contractor Name
Western States Surfacing
PROJECT NAME
2004-2005 asphalt rubber chip seal
RMP File Number
304
Date
9/2/2005
MO Ref
05-173; 07-045
Box
6571
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<br />CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br /> <br />No. 5907 <br /> <br />State of CALIFORNIA <br /> <br />County of Sacramento <br /> <br />On September 2. 2005 before me, Rosalie Ann Miszkiel, Notary Public <br />DATE NAME, TITLE OF OFFICER - EG., "JANE DOE, NOTARY PUBLIC" <br /> <br />personally appeared Thomas R Hucik <br /> <br />ROSALIE ANN MISzKIEL1 <br />. COMM. *1527201 a:I <br />~ Notary Public-California ~ <br />. SACRAMENTO C~ <br />My Comrn. Exp. Nov. 16, 2008 <br /> <br />NAME(S) OF SIGNER(S) <br />proved to me on the basis of satisfactory evidence to be the person(s) <br />whose name(s) is/are subscribed to the within instrument and <br />acknowledged to me that he/shelthey executed the same in <br />his/herltheir authorized capacity(ies) , and that by his/herltheir <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 /> <br />~ personally known to me - OR - 0 <br /> <br /> <br />VllR'Hc,,'" ~d and O~cial seal. <br /> <br /> <br />SIGNATURE OF NOTARY <br /> <br />Rosalie Ann Miszkiel <br /> <br />OPTIONAL <br /> <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 /> <br />CAPACITY CLAIMED BY SIGNER <br /> <br />DESCRIPTION OF ATTACHED DOCUMENT <br /> <br />0 INDIVIDUAL <br />D CORPORATE OFFICER <br /> <br />TITLE OR TYPE OF DOCUMENT <br /> <br />D PARTNER(S) <br />~ <br />0 <br />D <br />D <br /> <br />TITLE(S) <br />D LIMITED <br />D GENERAL <br /> <br />A TIORNEY-iN-FACT <br />TRUSTEE(S) <br />GUARDIANICONSERV A TOR <br />OTHER: <br /> <br />NUMBER OF PAGES <br /> <br />SIGNER IS REPRESENTING: <br />NAME OF PERSON(S) OR ENTITY(IES) <br /> <br />DATE OF DOCUMENT <br /> <br />Western Surety Company <br /> <br />SIGNER(S) OTHER THAN NAMED ABOVE <br /> <br />~~7In::: ?/QA <br /> <br />@ 1993 NATIONAL NOTARY ASSOCIATION. 8236 Remmel Ave-- p.o. Box 7184 . Canooa Parle. CA 91309-7184 <br />
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