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23B - PROJ - ROADWAY REHAB
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06/16/2015
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23B - PROJ - ROADWAY REHAB
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Last modified
6/11/2015 3:48:41 PM
Creation date
6/11/2015 3:30:35 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
6/16/2015
Destruction Year
2020
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CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT <br />A notary public or other officer completing <br />this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, <br />and not the truthfulness, accuracy, or validity of that document. <br />STATE OF CALIFORNIA <br />County of Orange <br />On 5/12115 before me, <br />Karen L, Ritto Notary Public, <br />Date <br />insert Name of Notary exactly as It appears on the official seal <br />personally appeared Andrew Waterbury <br />j <br />Nama(s) of Slgner(s) <br />I <br />who proved to me on the basis of satisfactory evidence to <br />be the person(x) whose name(X) is/=subscribed to the <br />within instrument and acknowledged to me that heMM04 <br />executed the same in his /W(M& authorized capacity(tex), <br />and that by his /MoCWeit signature(X) on the instrument the <br />person(x), or the entity upon behalf of which the person(4) <br />acted, executed the instrument. <br />/ `<sr {r. r n't rN <br />I certify under PENALTY OF PERJURY under the laws of <br />(r - CC:411 1)t 1 <br />� ttf ORANGb i phi <br />the State of California that the foregoing paragraph is true <br />and correcAatu,.N. <br />n <br />Witness mcial seal. <br />Signature <br />Place Notary Sea] Above <br />public Karen L . RIttO <br />OPTIONAL <br />Though the information below is not required by law, it may prove valuable to persons relying on the document <br />and could prevent fraudulent removal and reattachment of the form to another document. <br />Description of Attached Document <br />Title or Type of Document: Bid Bond <br />Document Date: 5112115 <br />Number of Pages: One <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: ,Andrew Waterbury <br />Signer's Name: <br />❑ Individual <br />❑ Individual <br />❑ Corporate Officer— Title(s): <br />❑ Corporate Officer— Title(s): <br />❑ Partner ❑ Limited ❑ General <br />❑ Partner ❑ Limited ❑ General <br />[J( Attorney in Fact <br />❑ Attorney In Fact <br />❑ Trustee • <br />❑ Trustee • <br />❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here <br />❑ Other: <br />❑ Other: <br />Signer is Representing: <br />Signer is Representing: <br />23B -28 <br />
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