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Craig A. Smith
SIBFL
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(18-11-01) Consult. Engin. Svs. for Golden Shores Pump Station Rehabilitation (CCNA)
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Craig A. Smith
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Last modified
12/11/2018 3:27:16 PM
Creation date
12/11/2018 3:03:53 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Golden Shores Pump Station CCNA
Bid No. (xx-xx-xx)
18-11-01
Project Type (Bid, RFP, RFQ)
RFQ
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STATE OF FLORIDA ) <br />COUNTY OF Palm Beach) <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: 4K <br />Title: Senior Vice President <br />The foregoing instrument was acknowledged before me this 10th day of <br />December _'20_18• by 5 <br />of person], as Senior Vice Pre: <br />Craia A. Smith & Associates, Inc. <br />executed]. <br />RMEJ <br />ate of Fbritlaon GG 08183847 <br />ident [type of <br />[name of party on behalf of whom <br />I <br />[name <br />authority], for <br />instrument was <br />Notary Public — Stage of Florida <br />Amanda J. Denton <br />Print or Type Commissioned Name <br />Personally Known X OR Produced Identification <br />Type of Identification Produced <br />DECEMBER28,2010 <br />193 <br />
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