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(12-04-02) Professional Architectural and Engineering Services - Firms Only
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Last modified
2/2/2016 3:57:38 PM
Creation date
2/2/2016 3:57:15 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Professional Architectural and Engin. Svcs
Bid No. (xx-xx-xx)
12-04-02
Project Type (Bid, RFP, RFQ)
RFQ
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I <br /> / ' ANTI KICKBACK <br /> 1 G(- z <br /> City of Sunny Isles Beach <br /> -• <br /> 18070 Collins Avenue <br /> 1 °S1� ;o r,o P"a +s Sunny Isles Beach,FL 33160 <br /> ,vh 'sa Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ' ANTI-KICKBACK AFFIDAVIT <br /> I STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF Alachua ) <br /> II, 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 /> I / <br /> By: Larry J. Marek �D. <br /> ITitle: President <br /> IThe foregoing instrument was acknowledged before me this 26th day of <br /> April , 20 12 , by Larry J. Danek. Ph.D. [name <br /> 1of person], as President [type of authority], for <br /> Environmental Consulting & Technology, Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> ' AFFIX NOTARY STAMP HERE: (N <br /> l <br /> INotary Public — State of to ida <br /> I Teresa S. Warrington <br /> Print or Type Commissioned Name • <br /> TERESA S.WARRINGTON <br /> Notary Public,State of Florida <br /> I <br /> Personal) Known X OR Produced Identification My comm.exp.Aug.16,2013 <br /> Personally Comm. No. DD 901098 <br /> Type of Identification Produced <br /> I <br /> I <br /> I <br /> 1 DECEMBER 28.2010 7 of <br />
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