Common use of SIGNATURES AND ACKNOWLEDGEMENT Clause in Contracts

SIGNATURES AND ACKNOWLEDGEMENT. Public Agency: By: Assistant Secretary, Governing Board XXXXX X. XXXXXXX, Director of Purchasing & Contracts Note to Contractor: (1) Execute acknowledgement form below, and (2) if a corporation, affix Corporate Seal. Contractor hereby also acknowledging awareness of and compliance with Labor Code S1861 concerning Worker's Compensation Law. Contractor: By: (CORPORATE SEAL) (Designate Official Capacity – NAME) Print NAME and TITLE License Number Federal ID Number NOTARY PUBLIC ============================================================================================= STATE OF CALIFORNIA ) ) ss. COUNTY OF CONTRA COSTA ) On , before me, , Notary Public, personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing is true and correct. Witness my hand and official seal. Notary Public [SEAL]

SIGNATURES AND ACKNOWLEDGEMENT. Public Agency: By: Assistant Secretary, Governing Board XXXXX X. XXXXXXX, Director of Purchasing & Contracts Contract Services Note to Contractor: (1) Execute acknowledgement form below, and (2) if a corporation, affix Corporate Seal. Contractor hereby also acknowledging awareness of and compliance with Labor Code S1861 concerning Worker's Compensation Law. Contractor: By: (CORPORATE SEAL) (Designate Official Capacity – COMPANY NAME) Print NAME and TITLE License Number Federal ID Number DIR REGISTRATION NUMBER Expiration Date NOTARY PUBLIC ============================================================================================= STATE OF CALIFORNIA ) ) ss. COUNTY OF CONTRA COSTA ) On , before me, , Notary Public, personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing is true and correct. Witness my hand and official seal. Notary Public [SEAL]