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(11-04-03) Stormwater Catch Basin Cleaning
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Last modified
9/10/2015 9:51:13 AM
Creation date
5/26/2011 10:49:56 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Storm Water Catch Basin Cleaning
Bid No. (xx-xx-xx)
11-04-03
Project Type (Bid, RFP, RFQ)
Bid
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S <br />1 }x9 <br />V v)z <br />1 a;j <br />n <br />y� f. <br />w4my is, <br />STATE OF FLORIDA ) <br />COUNTY OF sac ) <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: VUnyc c.46c <br />Title: <br />The foregoing instrument was acknowled ed before me this 2-41 day of <br />j� <br />20, by �o2SE iah�►c [name <br />of perso ], as [type of authority], for <br />Go an / [name of party on behalf of whom instrument was <br />executed]. *ealcazze <br />AFFIX NOTARY STAMP HERE: <br />Clau:ii8 KP:yrez <br />My nmm s5 + ^^ OJIQURnn <br />Personally Known ✓ OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28,2010 7 of 7 <br />
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