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The Stout Group
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(21-08-01) Utility Undergrounding Conversion for Golden Shores
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The Stout Group
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Last modified
9/29/2021 8:57:38 AM
Creation date
9/28/2021 4:58:48 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Golden Shores Utility Undergrounding
Bid No. (xx-xx-xx)
21-08-01
Project Type (Bid, RFP, RFQ)
Bid
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O�SVµNY JS`Fre <br />� F <br />ti <br />•k <br />l9➢_ - .. _Ort r <br />F L O R` 9� <br />carr of su*+ �Na <br />STATE OF FLORIDA <br />COUNTY OF Miami Dade <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: <br />Title: Manager <br />The foregoing instrument was acknowledged before me this 28 day of <br />September 20 21 , by Jose Maria Sanchez III [name <br />of person], as Manager [type of authority], for <br />The Stout Group, LLC [name of party on behalf of whom instrument was <br />executed], <br />AFFIX NOTARY STAMP HERE: <br />SppY v� <br />YVETTE ZULUAGA <br />'My COAMISSION 9 GG173146 <br />oFfl� EXPIRES: January U7, 2022 <br />(Z) (M= g 4� <br />No4ar�ypPubli — tate o rids <br />Y`CJf iC. <br />Print or Type Comm' sioned Name <br />Personally Known X OR Produced Identification <br />Type of Identification Produced Kv%o-.uy\ <br />7of12 <br />
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