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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
Fields
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-PURPOSE Al. -- iOWLEDGMENT ~ No. 5s07 <br /> <br /> State of CALIFORNIA <br /> <br /> ,County of SACRAMENTO <br /> <br /> On July 18, 20fl3 beforeme, TinaN. Handy, Notary Public <br /> DATE NAMe, T~TLE OF OFFICER - F-G., "JANE DOE, NOTARY PUBLIC" <br /> <br /> personally appeared Melody Lumpkin <br /> NAME(S) OF SIGNER(S) <br /> [] personally known to me - OR - [] proved to me on the basis of satisfactory evidence to be the person(s) <br /> whose name(s) is/are subscribed to tho 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 /> ! "~ 7!i~[A N. HANDY ~ signature(s) on tho instrument the person(s), or the entity upon <br /> /.'~' ~t~-.\ COM, M, #1268113 m behalf of which the person(s) acted, executed tho instrument. <br /> <br /> ~~i~i..~~ WITNESS my hand and official seal:~ <br /> <br /> Tina N. Handy <br /> <br /> OPTIONAL <br /> <br /> Though tho 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 DESCRIPTION OF ATTACHED DOCUMENT <br /> <br /> [] INDIVIDUAL <br /> [] CORPORATE OFFICER <br /> <br /> TITLE OR TYPE OF OOCUMENT <br /> TrrLE(S) <br /> [] PARTNER(S) [] UM TED <br /> GENERAL <br /> [] ATTORNEY-IN-FACT <br /> [] TRUSTEE(S) <br /> [] GUARDIAN/CONSERVATOR NUMBER OF PAGES <br /> [] OTHER: <br /> <br /> SIGNER IS REPRESENTING: DATE OF DOCUMENT <br /> NAME OF PERSON(S) OR ENTITY(lES) <br /> <br /> WESTERN SURETY COMPANY <br /> <br /> SIGNER(S) OTHER THAN NAMED ABOVE <br /> <br /> S-40671GEEF 2/98 ~ 1993 NATIONAL NOTARY ASSOC[ATICN · 8236 Rammer Ave., P.O. Box 1184 · Canoga Park, CA 91309-7184 <br /> <br /> <br />
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