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BID TITLE: BID 19 -17 -12 -HR BID NUMBER: ROOFING MAINTENANCE & REPAIRS <br />SCHEDULE "A" <br />(Continued) <br />I, the undersigned hereby agree to furnish the items and / or services described in this Invitation for Bid. <br />I certify that I have read the entire document, including the Specifications, Requirements, Terms & <br />Conditions and Schedules, and agree to furnish the items and services under the requirements of the <br />Bid. <br />I also certify that this Bid is submitted without prior understanding, agreement, or connection with any <br />corporation, firm or person submitting a Request for Submittal for the same materials, services, and <br />supplies and is in all respects fair and without collusion or fraud. <br />The Respondent certifies by his/her signature that the person signing this Certification is authorized to <br />bind the firm by their signature. <br />Company Name: <br />Address <br />City <br />Phone# <br />Signature: <br />Printed Name: <br />FEID or Social Security No. <br />State Zip <br />Fax# E -Mail <br />Title <br />SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE STATEMENT <br />Please be advised that pursuant to Section 119.071(5) (a) 2.a., Florida Statutes, the City of Sunrise ("City") <br />discloses that the City requests your social security number for the purpose of payroll eligibility verification, <br />processing employment benefits, income reporting, tax reporting, background checks on employee applicants, <br />advisory board applicants and other City program volunteers. Social security numbers are also used as a unique <br />numeric identifier and may be used for search purposes. <br />Revised 6/27/18 Page 70 <br />