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BEN'S ASPHALT, INC.
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Last modified
11/14/2024 2:56:12 PM
Creation date
9/22/2015 4:59:11 PM
Metadata
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Template:
Contracts
Company Name
BEN'S ASPHALT, INC.
Contract #
13-2638
Agency
Public Works
Council Approval Date
8/4/2015
Expiration Date
2/5/2016
Insurance Exp Date
3/1/2016
Destruction Year
2019
Notes
Project
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CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 <br />.zrercr,c:rs.c�.sr.�r�r�c-,cc,�rsr�.c�>r,:.rc�a,.e�;LrcnLrrrc:r.�r,�o,�r,�r�e�r�.r.�r�,.�ccrcr.�.r,� rcoce:�s�,rrs <br />Ll See Attached Document (Notary to cross out lines 1-6 below) <br />[X See Statement Below (Lines 1-6 to be completed only by document signer[s), not Notary) <br />Signature of Document Signer No. 1 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 ORANGE <br />LESHERWOOD <br />COM12111182 <br />P'! NOTARY PUBM. LIC *CALIFORNIA j <br />ORANGE COUNTY <br />Gomm. Exp. JULY 27, 2017 �` <br />V'v'Y"W v"Y"'•'v"V"'v"V"Yw <br />Subscribed and sworn to (or affirmed) before me <br />on this 11TH day of JUNE 20 15 <br />by Date Month Year <br />(1) SPENCER FLAKE <br />(and (2) i1 <br />Name(s) of Signers) <br />proved to me on the basis of satisfactory evidence <br />to be the person(s) who appeared before me. <br />Signature &�) <br />Signa ure of Notary Public <br />Seal <br />Place Notary Seal Above <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 />Document Date: <br />Number of Pages: Signer(s) Other Than Named Above: <br />02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 <br />
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