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Agmt13 Blocka Construction, Inc.
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Agmt13 Blocka Construction, Inc.
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Last modified
2/7/2013 12:45:11 PM
Creation date
2/7/2013 12:43:27 PM
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Template:
Agreement
Contractor Name
Blocka Construction, Inc.
PROJECT NAME
Sanitary Sewer Pump Station 10 Improvemenets Project
RMP File Number
304
Date
2/7/2013
MO Ref
13-002
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� GENERAL ALL-PiJRPOSE ACKNOWLEDGMENT <br /> State of Arizona <br /> County of Maricopa <br /> On January 25,2013 before me, Vicki L.Breuni�,Notary Public <br /> Date Name and Title of Officer(e.g.,"Jane Dce,Notary Public") <br /> personally appeared David G.Jensen <br /> Name(s)of Signer(s) <br /> X Personally known to me <br /> ❑proved to me on tbe basis of satisfactory evidence <br /> to be the person(s)whose name(s)is/are subscribed to the within <br /> instrument and acknowledged to me that he/she/they executed the <br /> OFFICIAL SEAL same in his/her/their authorized capacities and that by his/her/their <br /> VICKI L. BREUNIG <br /> �y;y,�: Notary Public-State of Arizona signature(s)on the instrument the person(s), or the entity upon <br /> MARICOPA COUNTY behalf of which the erson s acted,executed the said instrument. <br /> My Comm. Expires Mar. 31,2013 p � � <br /> WITNESS my hand and official seal. <br /> � � <br /> Signature of Notary Public <br /> ' OPTIONAL =` <br /> Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent <br /> reattachment of this form. <br /> CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCLJMENT <br /> (_) INDIVIDUAL <br /> �—) <br /> Payment Bond#024048968 <br /> TITLE(S) TTTLE OR TYPE OF DOCUMENT <br /> (_) PARTNER(S) (_) LIMITED <br /> (_) (_) GENERAL <br /> NiJMBER OF PAGES <br /> LX) ATTORNEY-IN-FACT <br /> (_) TRUSTEE(S) <br /> (_) GUARDIAN/CONSERVATOR <br /> (_) OTHER January 25, 2013 <br /> DATE OF DOCUMENT <br /> SIGNER IS REPRESENTING: <br /> NAME OF PERSON(S)OR ENTITY(IES) Erin J. Brown, Witness <br /> Additional Signatures <br /> Liberty Mutual Insurance Company <br />
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