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Southern Underground Industries, Inc.
SIBFL
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(16-04-01) 172 Street Drainage Repairs
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Southern Underground Industries, Inc.
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Last modified
5/2/2016 4:56:24 PM
Creation date
5/2/2016 4:54:16 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
172nd Drainage Repairs
Bid No. (xx-xx-xx)
16-04-01
Project Type (Bid, RFP, RFQ)
Bid
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SINNY the <br /> t 1 t <br /> cfee <br /> ~�, ANTI - KICKBACK <br /> )• City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> *r '�.no�' Sunny Isles Beach,FL 33160 <br /> 'o. sue '# Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Miami-Dade <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: Juan Barreneche, Vice President <br /> The foregoing instrument was acknowledged before me this 2nd day of <br /> May 2016 by Juan Barreneche [name <br /> of person], as Vice President [type of authority], for <br /> Southern Underground Industries, Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> lop . -oir at_ <br /> .r.`I NOARYA�� No1. ryP blic — Sr •�~ = ida <br /> ``�-'. - STATE OF FLORIDA <br /> ¶-r-':" Ca u P FF069798 Mayra . Aguiar <br /> • Expires 11/12/2017 Print or Type Commissioned Name <br /> Personally Known X OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 28,2010 7 of 10 <br />
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