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<br />11/13/1998 13:48 <br />/ <br /> <br />305-9474386 <br /> <br />SUNNY ISLES BEACH <br /> <br />PAGE 03 <br /> <br />A"!:tacp. t.",~;.:.. if <br /> <br />:\'ETRO-DADt: COl!~TY AFFIDAVITS <br /> <br />The cOl1lmclIn~ Il1di'Idu;lI or cnlm' (~o\'e:mlncolill or olhcf\'ISC' shall Indicate: b~ an RX. all Hffil1l\l\s thill pcnalIl Ie I:,is <br />ccnlr-.JCI Jnd shallllldlcalc b~' an "Nt A" al/ afTidoJ\'IIS Ihnl do nOl pen..llo 10 Ihis c:cmlracl. All blnnk SDacc:s 1111151 be filled <br /> <br />The: METRO-DADE COUN1l' OWNERSHIP DISCLOSL"RE AFFIOA VIT: METRO-DADE COUNTY EMPLOYMENT <br />DISCLOSURE AFFIDAVlT: ~ETRO~.pADE CRIMINAL RECCFm AFF1DAVli: and DISABILITY NONDISCRIMINATION <br />AFFtDA VIT shall nOI pl:l'\ilin to contrac:tS with Ihe: Uniled Slalcs or any of ils dcpanrnc:ntJ or a~c:nr;ic.s t1um:or. Ihl! Slate or any <br />pohliQI subdivision or i1~c:ncy lIu:rcof or :any munic:ipaht,.- of (Jus Slate. The METR~O.-..oE F AMIL Y LEAVE AFFIDA \I1T shall <br />1101 penaln 10 C;OnlT:aClS ",ilh thc United Slates or :any of its de:panme:nts or agencies Or Ihe Slale of Flonda Dr an:. pohucal <br />subdi\'lslon or ilgcn~' lhc:r=f: it shall. however. pen.ain to munitipaJitiC".s of thl! Stale of Florida. All olher eOnlractlril; enllUes or <br />IIldi\'iduals shall t'Cad carefully caeh ;UTIda\'il 10 delemunc: ~'helher or nOI il penains 10 Ihis COnlTill:t. <br /> <br />I. <br /> <br />James DiPietro <br />A ('fj a nl <br /> <br />. being til$t duly swcm NtC: <br /> <br />The rullleg.Jl narne ill1d busl/1css address of Ihe pr:rsonlSl or e:nlit~ conlrnellng or lr.msacllng business WHit Mclr~Dacic: County arc <br />(POSI Office addresses arc nol acce:ptable): <br /> <br />65-078-4647 <br />Federal Elnplo~'l:r Ide:H1ticallon Number lIf none. SOCial Sec~n~'l <br /> <br />City of Sunny Isles Beach <br />Ni\InC of Enll~'. Inclinduo;allsl. Pl'lnnc~. or Corpor;allon <br /> <br />OOlns BUSiness As (If same as abo'.e. JCj)ve blank) <br /> <br />17070 Collins Avenue <br />Slreet A~drcss <br /> <br />Sunny Isles Beach. FL <br />City Slale <br /> <br />33160 <br /> <br />Zip Code: <br /> <br />METRO-DA.DE COlJ'N"n' DISCLOSURE AFFlOA....rr eSec. 2.11.1 of the Coun~' Code) <br /> <br />i i r tile: COlllract or business lransac:t10n is with. corpot'alion. Ihe full legal name: and business alic1rw shall be <br />pro\'ldcd ror c.,c:h omc.c:r and dita:\or and each stockholder who hOlds dil'l$lly or inc1irc:ctly rh'c pera:nl lS./o) Dr <br />Inorc: of Ihe co~ration's stock. If the contract or businc:ss transa~on is ,,'ilh a pannershtp. .he fo~going <br />infonnaLJon shall be provlaai for ~h panncr. If the CantlCtc;1 or b1.lSincss transaction is ",ilh a lNlL the Nil legal <br />n:amc ;lnd addRsI shall be prvvidU for each INStCl: and each beneficiary. Thl! foregoing requircmcnl$ shall nat <br />penain to contr.ll:lI with publicly-tradcd cOI'pOM'llions or 10 c:anlracl.S """h the United States or any depanmenl or <br />agcncy Ihereof. the Slale or any p:llllical subcli,..ision or agen~.. thereof or any munjcipaJi~' of tNs Sl.1lc. .~IJ such <br />lIames and ad.dt'cs.5cs arc (Post Office ;ddn::scs are not ac.c:c~"able): <br /> <br />Full LepJ Nlunc <br /> <br />Addn:u <br /> <br />O\\"n,~hip <br /> <br />N{A <br /> <br />% <br /> <br />-/.. <br /> <br />% <br /> <br />1/ y. <br />.. I_~S!I'IIIJ-.\~\I <br /> <br />P:lgc I or S <br />