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Disaster Program & O perations Inc.
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RFP No. 18-04-03 Disaster Debris Monitoring Services Financial Recovery Assistance
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Disaster Program & O perations Inc.
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Last modified
5/10/2018 4:40:30 PM
Creation date
5/10/2018 4:06:39 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Disaster Debris Monitoring Svcs & Financial Recovery Assist
Bid No. (xx-xx-xx)
18-04-03
Project Type (Bid, RFP, RFQ)
RFP
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SUNNY is4eJ <br /> Q <br /> � � s }�" ANTI — KICKBACK <br /> City of Sunny Isles Beach <br /> or. 18070 Collins Avenue <br /> sF ''• F L O 5°7 Sunny Isles Beach,FL 33160 <br /> rr or sus '' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTE-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Ivilcrr►+ QQc A ) <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: ctb(l(i(e i fi <br /> Title: YrScLt%1A- <br /> S <br /> The foregoing instrument was acknowledged before me this ,`qday of <br /> ,3t y , 20 F' by �, � [name <br /> of person],/ as /`._ /., [type of authority], for <br /> 7 [ ame of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: , <br /> 1 _ . <br /> Flo, _f Public— S;vice of Florida <br /> P""% HASHATH MORALES <br /> MY COMMISSION#FF977061 l n D Li <br /> ExpIRFS:March 30,2020 V\ u�J` <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced ,P���L.G . <br /> 7 of 10 <br />
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