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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 />c.~~~~~~~~L&Y~~~~~ <br /> <br />State of Californir - <br /> <br />County of ,S-C (J f1 is I au _S <br />C¡'-&"C'r;; <br /> <br />Date <br /> <br />before <br /> <br />me, <br /> <br /> <br />(?r <br /> <br />On <br /> <br />personally <br /> <br />appeared <br /> <br />Name(s) of Signer(s) <br /> <br />/' <br />~allY known to me <br /> <br />~.---. --TËRÊSALSzŸPÊÃÌ <br />- COMM. #1577053 :c: <br />~ '. NOTARY PU8l1C-CALIFORNIA :s! <br />:E STANISLAUS COUNTY ~ <br />L__--~~~~C:2~J <br /> <br />D proved to me on the basis of satisfactory evidence <br />to be the person(s) whose name(s) is/are subscribed <br />to the within instrument and acknowledged to me that <br />he/she/they executed the same in his/her/their <br />authorized capacity(ies) , and that by his/her/their <br />signature(s) on the instrument the person(s), or the <br />entity upon behalf of which the person(s) acted, <br />executed the instrument. <br /> <br />Place Notary Seal Above <br /> <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: <br /> <br />Document Date: <br /> <br />Number of Pages: <br /> <br />Signer(s) Other Than Named Above: <br /> <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />0 Individual <br />0 Corporate Officer - Title(s}: <br />0 Partner - 0 Limited 0 General <br />0 Attorney in Fact <br />0 Trustee <br />0 Guardian or Conservator <br />0 Other: <br /> <br />Top of thumb here <br /> <br />Signer's Name: <br />0 Individual <br />0 Corporate Officer - Title(s}: <br />0 Partner - 0 Limited 0 General <br />0 Attorney in Fact <br />0 Trustee <br />0 Guardian or Conservator <br />0 Other: <br /> <br />RIGHT THUMBPRINT <br />OF SIGNER <br /> <br />RIGHT THUMBPRINT <br />OF SIGNER <br /> <br />Top of thumb here <br /> <br />Signer Is Representing: <br /> <br />Signer Is Representing: <br /> <br />~~~~~~-.-,....~~~~ <br />@2004 National Notary Association' 9350 De Soto Ave., P.O. Box 2402' Chatsworth, CA 91313-2402 Item No. 5907 Reorder: Cali Toll-Free 1-800-876-6827 <br />
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