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Item 28 - Water Well, Pump, and Motor Rehabilitation and Repair Services
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08/17/2021 Regular
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Item 28 - Water Well, Pump, and Motor Rehabilitation and Repair Services
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4/9/2024 11:53:28 AM
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8/17/2023 4:08:30 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Clerk of the Council
Item #
28
Date
8/17/2021
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CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 <br />® See Attached Document (Notary to cross out lines 1-6 below) <br />5-See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) <br />Signature of Document Signer No. I Signature of Document Signer No. 2 (if any) <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California <br />County of San Bernardino <br />HERMINEA Gii_BON <br />q COMM, # 222 W4 F, <br />NOTARY PUBLIC - CALIFORNIA o <br />SAN BERNARDINO COUNTY k,0 <br />N f Comm. Expires Wx 11, 2021 <br />Seal <br />Place Notary Seal Above <br />Subscribed and sworn to (or affirmed) before me <br />on this 26th day of May 20 21 <br />by Date Month Year <br />(1) Todd A. Howard <br />(and (2) NIA ), <br />Namefa)' of Signerfgy <br />proved to me on the basis of satisfactory evidence <br />to be the person who appeared before me. <br />Signature YVWY�I <br />Signature of Notary Public <br />Herminia Gilbon, Notary Public <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: <br />Non -Collusion Affidavit <br />Number of Pages: 2 Signer(s) Other Than Named Above: <br />Document Date: No Date <br />None <br />02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 <br />19 <br />
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