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anti-kickback_form_sparc
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RFP No. 19-07-02 Citywide Re-Branding Services
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anti-kickback_form_sparc
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8/14/2019 3:44:12 PM
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STATE OFA ) <br />COUNTY OF •1 DZ- ) <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 />By: Richard Cassis <br />Title: President <br />The foregoing instrument was acknowledged before me this <br />ust 2019 by Richard Cassis <br />of person], as President <br />Sparc Design, Inc. <br />executed]. <br />[type <br />[name of party on behalf of <br />of <br />whom <br />9th day of <br />[name <br />authority], for <br />instrument was <br />AFFIX NOTARY STAMP HERE: <br />Notary Public — State of -Fluidal- <br />NATASA SAS IC <br />Official Seal �/W/T0— S f13/c <br />Notary Public— State of Illinois ��'I <br />My Commission Expires Jan 4, 2022 Print or Type Commissioned Name <br />Personally Known 1/ OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />
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