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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-PURPOSE A( IOWLEDGMENT No. 5907 <br />State of CALIFORNIA <br />County of SACRAMENTO <br /> <br /> On July ! 8, 2003 before me, Tina N. Handy, Notary Public <br /> DATE NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC" <br /> personally appeared Melody Lumpkin <br /> NAME(S) OF SIGNER(S) <br /> [] personally known to me - OR - [] proved to me on the basis of satisfacto~' evidence to be the person(s) <br /> whose name(s) is/are subscribed to the within instrument and <br /> acknowledged to me that he/she/they executed the same in <br /> his/her/their authorized capacity(les), and that by his/her/their <br /> ~'~-'~'~"?JA N. HANDY~~'~ ~ '~ signature(s) on the instrument the person(s), orthe entity upon <br /> ~'~*~' ~[~.~ COMM. #1268113 m bahalf of which the person(s) acted, executed the instrument. <br /> 'sl~l Notary Public-California ~ <br /> a L~?'~2 SA~?~AMENTOCOUNTY I~ <br /> ~.~':[~;~ WlTNES~S ,my hand and offiFial seaJ~ <br /> <br /> // - -- - S~NATURE ~)F/N~ARY <br /> Tina N. Hand), ~/ U <br /> <br /> OPTIONAL <br /> <br /> Though the data balow is not required by law, it may prove valuable to persons relying on the document and <br /> could prevent fraudulent mattachment 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 DOCUMENT <br /> TITLE(S) <br /> [] PARTNER(S) [] LIMITED <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 C 1993 NATIONAL NOTARY A~SSOCIATIO N · 8236 Remmet Ave.. P,O, Box 7184 * Canoga Park~ CA 91309-7184 <br /> <br /> <br />
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