Bermello Ajamil & Partners, LLC Bid Document (28)

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94 | CiTY OF SUNNY iSLES BEACH | RFQ #26-07-01 CONTiNUiNG PROFESSiONAL ARCHiTECTURAL AND ENGiNEERiNG CONSULTiNG SERViCES (CCNA) AFFIDAVIT OF COMPLIANCE WITH FOREIGN ENTITY LAWS City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 The undersigned, on behalf of the entity listed below hereby attests under penalty of perjury as follows: 1. Entity is not owned by the government of a foreign country of concern, as defined in Section 287.138, Florida Statutes. 2. The government of a foreign country of concern does not have a controlling interest in Entity, as defined in Section 287.138, Florida Statutes. 3. Entity is not organized under the laws of a foreign country of concern, as defined in Section 287.138, Florida Statutes. 4. Entity does not have a principal place of business in a foreign country of concern, as defined in Section 287.138, Florida Statutes. 5. The undersigned is authorized to execute this affidavit on behalf of Entity. Date: ____________________, 20___ Signed: Entity: Name: Title: STATE OF COUNTY OF The foregoing instrument was acknowledged before me, by means of physical presence or online notarization, this ____ day of ______________, 20____, by _______________________________, as ____________________________ for _____________________________________________________, who is personally known to me or who has produced ________________________ as identification. Notary Public Signature: State of Florida at Large (Seal) Print Name: My commission expires: 29 July Maria Luisa Murillo x 26 Bermello Ajamil & Partners, LLC Vice President/ Partner Randy Hollingworth 4/6/2027 July 29 26 Bermello Ajamil & Partners, LLC Vice President/ PartnerRandy Hollingworth (Personally known to me) Florida Miami Dade