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Name of Affiliate <br />or entity <br />Name of County Commissioner Relationship <br />or employee <br />(Signature) <br />STATE OF `13 A U <br />(Date) <br />COUNTY OF \VV,�----410'V <br />The foregoing inst ment was acknowledged before me this 2(3 day of AA,, , , 2014, by <br />I ') 0- , who isesrsonally kr3own to me or who has produced <br />as identification. <br />SIGN: <br />PRINT: <br />NOTARY PUBLIC <br />sb(ooft,..k v1.64 - <br />Notary Public, State at large <br />My Commission Expires:10.3 . \S" <br />(Seal <br />DEBORALT-1 WEST <br />MYCOt;;,;,, ., .;r=EEI30889 <br />EXPIRE : • ',;,,,.. ?3, 2033 <br />'HOYARY Cl. Notary Discount -,.y:._ <br />t.:4 \.%OevifirAtrefe <br />00452-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1137-01d Dixie Hwy Resurfacing 53rd St to 71st St\Admim\bid documents\Contract <br />