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The Celebration Source Inc.
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(16-08-02) Event Rides
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Bid 16-08-02 Event Rides
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The Celebration Source Inc.
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Last modified
8/24/2016 4:07:30 PM
Creation date
8/24/2016 4:06:07 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Events Rides Rental
Bid No. (xx-xx-xx)
16-08-02
Project Type (Bid, RFP, RFQ)
Bid
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• <br /> SVNN♦ <br /> V%/_:Tn •f <br /> ANTI - KICKBACK <br /> VI- 11 IZ <br /> City of Sunny Isles Beach <br /> 18070 Corns Avenue <br /> 0 <br /> Sunny It Beath.FL 33160 <br /> o. sus' Tdephme:(305)947-0606 Far(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Brtrvetrd ) <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 /> o <br /> By: ./ / Ate - <br /> Title: Pres;ciev1+ <br /> 44 The foregoing instrument was acknowledged before me this day of <br /> u c� , 20 R. by 01 i c e_l Ca w1()7 [name <br /> of p6rson], as Pres i d e n l [type of authority], for <br /> Theo/tbrsr/itvn 15nurce. T.nr. [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> No r ubli — State of Florida <br /> 11$.1.04 JEKTORAYALA <br /> ,io\.. MY COYUISSION t FF 911313 <br /> - 'n 4 • iR S Oetobor 3 2n1a <br /> C1 tfP <br /> Print or Type . ' k"-!w t:610rNxru^ <br /> pan• <br /> Personally Known OR Produced IdAntification177 <br /> Type of Identification Produced F C- e- <br /> CECELBER 28.2010 7 of 7 <br />
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