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Agmt03 Western States Surfacing
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Agmt03 Western States Surfacing
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Last modified
7/21/2005 12:24:32 PM
Creation date
8/25/2003 10:39:33 AM
Metadata
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Template:
Agreement
Contractor Name
Western States Surfacing
PROJECT NAME
asphalt rubber chip seal proj 03-03
RMP File Number
304
Date
7/28/2003
MO Ref
03-154 03-276
Box
5941
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CALIFORNIA ALL-PURP(k..~ ACKNOWLEDGMENT - No. 5~O7 <br /> <br /> State of <br /> <br /> County of .q"PAT.3T RT .A~"Lq <br /> <br /> On ~Y 22, 2003 before me, P~ D, ~, N~Y P~IC , <br /> DATE NAME, TITLE OF OFFICER- E.G. "JANE DOE, NOTARY PUBUC <br /> <br /> personally appeared ~Y B. ~.:.:.) <br /> N~E(S) OF SIGNER(S} <br /> <br /> ~ pemonally known to me - OR - ~ proved to me on the basis of satisfactou evidence <br /> to be the person(s) whose name(s) <br /> subscribed to the within instrument and ac- <br /> knowledged to me that he~ executed <br /> the same in his~ authorized <br /> capacity(les), and that by his~ <br /> signature(s) on the instrument the person(s), <br /> or the entity ~upon behalf of which the <br /> person(s) acted, executed the instrument. <br /> <br /> ~ COMM. e1713~ [ ~SS my ~and and official seal. <br /> <br /> ................................. SIG~TU R~ NOTARY <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 could prevent <br /> fraudulent reattachment of this form. <br /> <br /> CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT <br /> [] INDIVIDUAL FAITHFUL PERFORMANCE BOND <br /> [] CORPORATE OFFICER CI~ OF Z~D~OOD CItY <br /> <br /> PRESIDS~qT TITLE OR TYPE OF DOCUMENT <br /> TITLE(S} <br /> <br /> [] PARTNER(S) [] LIMITED <br /> [] GENERAL SIX PAGES INCLUDING THIS ONE <br /> [] A'I-rORNEY-IN-FACT NUMBER OF PAGES <br /> [] TRUSTEE(S) <br /> [] GUARDIAN/CONSERVATOR <br /> [] OTHER:, JULY 18, 2003 <br /> DATE OF DOCUMENT <br /> <br /> SIGNER IS REPRESENTING: <br /> NAME OF PERSON(S) OR ENTITY(IRS) <br /> WES'.L'Jc;F,N STATES SURFACING INC. SIGNER(S) OTHER THAN NAMED ABOVE <br /> <br /> ©1993 NATIONAL NOTARY ASSOCIATION · 8236 Remmet Ave,, P,O. Box 7184 * Canoga Park, CA 91309-7184 <br /> <br /> <br />
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