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Shiff's Exhibit 1 - 15
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ITB 19-01-01 Gateway Park Center
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Shiff's Exhibit 1 - 15
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Last modified
5/16/2019 3:33:26 PM
Creation date
5/16/2019 3:12:50 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Gateway Park Center
Bid No. (xx-xx-xx)
19-01-01
Project Type (Bid, RFP, RFQ)
Bid
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• <br /> SJNN•isf <br /> ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> % ate'".•°R . Sunny Isles Beach,FL 33160 • <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF BROWARD ) <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 officals 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: JUSTEN SHIFF <br /> Title: PRESIDENT <br /> The foregoing instrument was acknowledged before me this 6 day of <br /> MAY , 20 19 , by JUSTEN SHIFF [name <br /> of person], as PRFSIf1FNT [type of authority], for <br /> • SHIFF CONSTRUCTION& DEVELOPMENT [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> _ Nota Public— State of Florida <br /> RIA O.PICONE <br /> • 41• . ; ; tAY COMMISSION#GG 015375 • RIA Q. PICONE <br /> '°' EXPIRES:September 8,2020 <br /> M '^`�c Bonded Thru ttotary Public Underwriters <br /> ,o• F«,. Print or Type Commissioned Name <br /> Personally Known X OR Produced Identification <br /> Type of Identification Produced <br /> • <br /> • .DECEMBER 28.2010 • _ - 7 Of 8' <br />
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