My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
Anti-kickback
SIBFL
>
City Clerk
>
Bids-RFQ-RFP
>
ITB
>
(19-01-01) Gateway Park Center
>
Responses
>
TGSV Enterprises
>
Tab 9 Forms & Attachments
>
Anti-kickback
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/13/2019 3:38:05 PM
Creation date
3/13/2019 3:38:02 PM
Metadata
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
Page 1 of 1
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
O�SVHNY IS`��B <br />SP DD)r. OT. <br />or SV14 o <br />STATE OF FLORIDA ) <br />COUNTY OF Miami -Dade ) <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br />will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br />by an officer of the corporation. <br />Richard Gomez <br />Title: Vice President <br />The foregoing instrument acknowledged before me this Zlnd day of <br />rA Q4 20by 1 ArrA C-nmP [name <br />of personl, as , ��A [type of authority], for <br />~TI_SV �'i -� r vse_"' - (name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: 1 <br />oayP� ISAt3ELCAMEJO SMITH N tary Public —of Florida <br />?' MY COMMISSION # GG 186668 <br />EXPIRES: June 14, 2022 <br />Bonded Thru Notary Public Underwiiters Isabel Came j o -7Mk:it h <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER28,2010 7 Of 8 <br />
The URL can be used to link to this page
Your browser does not support the video tag.