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2400 - All American Asphalt - Walnut Grove Ave Resurfacing Project Phase I from Marshall St. to the Northerly City Limit (C21101)StatlFall'M STATE FARM'S PO Box 2368 Bloomington IL 61702-2368 90A ATI 23 002616 0093 CITY OF ROSEMEAD 8838 VALLEY BLVD ROSEMEAD CA 91770-1714 1�I�'I...III'I..Ir'I���I�IIII�II1rlrl�l�lir111111111�illil�r1111 DATE OF NOTICE: MAR 08 2023 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. LADDITIONAL INSUREDS NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 1380-FA71-A NAMED INSURED: POLICY NO: 626 9108-E04-751 COVERAGE: ASPHALT PROFESSIONAL YR/MAKE/MODEL: 2012 FORD UTIL TRK BI AND PD LIABILITY ' SERVICES, INC VIN/CAMPER: 1 FDUF4GTOCEC39851 $ 1 MIL 960 6TH ST STE 101A# 164AGENT NAME: ADOLFO SALDANA $500 DED. COMP. $500 DED. COLL. NORCO CA 92860-1440 AGENT PHONE: (951)637-3100 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE FEB 16 2023 UNTIL TERMINATED g POLICY MESSAGES: g The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice W is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of 8 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. F FRT - This page is part of your document - DO NOT DISCARD - 20220772736 Recorder's111111111111111111111111111111111111111111111111111 Recorded/Filed in Official Records Angeles ry, California LEADSHEET 07/29/22 AT 02:42PM III I 111111111111111111111111111111 202207292950022 00022604263 IIIIIIIIIIIVUIIIIIIMIIIIIIIIVINIIIIIIIIIIIVI 013569778 SEQ: 02 FEES: TAXES: OTHER: Pages: 0004 0.00 0.00 0.00 PAID: 0.00 DAR - a>1 (intake) - THIS FORM IS NOT TO BE DUPLICATED - RECORDING REQUESTED BY CITY OF ROSEMEAD I AND WHEN RECORDED MAIL TO: Name City of Rosemead Street Address 8838 E. Valley Blvd. City & State Rosemead, CA 91770 ATTN: CITY CLERK Notice is hereby given that: '161i11�llllu Il�l0 2III!IIIIIIIIII Batch Number: 13569778 SPACE ABOVE THIS LINE FOR RECORDER'S USE 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the undersigned is: City of Rosemead 3. The full address of the undersigned is: 8838 E. Valley Blvd., Rosemead, CA 91770 4. The nature of the title of the undersigned is: In fee (If other than fee, strike "In fee" and insert, for example, "purchaser under contract of purchase", or "lessee" 5. The full names and full addresses of all persons, if any, who hold title with the undersigned are: Names Addresses N/A N/A 6. The names of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work of improvement herein referred to: Names Addresses N/A N/A (If no transfer made, insert, "none". 7. A work of improvement on the property hereinafter described was completed on: May 21, 2022 8. The name of the contractor, if any for such work of improvement was: All American Asphalt 9. The property on which said work of improvement was completed is in the City of Rosemead County of Los Angeles , State of California, and is described as follows: Walnut Grove Avenue Resurfacing Project Phase I - Marshall to the Northerly City Limit 10. The street address of said property is: as listed in No. 9 (If no street address has been officially assigned, insert "none" Signature of owner named Dated: 71"z-112-2- in paragraph 2: Michael Chung Director of Public Works By: City of Rosemead I certify (or declare) under penalty of perjury that the foregoing is true and correct. 7/z//ZZ, Date Rosemead, CA Place of Execution Michael Chung Director of Public Works City of Rosemead, California CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of On before me,WW 1�1` Date _ Here Insert Name and Title of the Officer personally appeared Nam eWof Signe who proved to me on the basis of satisfactory evidence to be the person a'f whose namexis/frre subscribed to the within instrument and acknowledged to me that he4�executed the same in his#&-,rfth authorized capacity, and that by hisA4 rA+m4r signatureX on the instrument the person, or the entity upon behalf of which the person ,,si)' acted, executed the instrument. NATALIE HAWORTH =� Notary Public - California Los Angeles County " My Commission N 2272060 Comm. Expires Dec 20, 2022 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature SignaturdPof Notary Public yr i iv1141►L Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document, 0'i'1 �Q, C1C �rn�� oy\ — akNi- Wtv2 Title or Type of Docum�jnt: Document Date: -7 / 21 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ©2019 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: U.G Ciiy I�mi�