Laserfiche WebLink
<br />PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST <br />Moving Services for Village Hall and <br />Police Department <br /> <br />I l.iNl)ERSTAND THAT TIlE SUBMISSION OF THIS FORi\{ TO TIlE CONTRACTING OFfICER FOR mR <br />PUBLIC ENTITY INDE?\1'fIFlliD IN PARAGR&\PH 1 (ONE) ABOVE IS FOR TH.&\ T PUDLIC ENTITY om y, <br />M'D TIIA T TIITS FORM IS V A1..lD TIIROUGH DF.CE:rv.mnR 31 OF TIIE CALENDAR YEAR IN WInCH IT <br />IS FILED. I ALBO U1\'DIIRSTA1'm THAT I A.M RRQUlRTID TO IN"FORM: 1HE PUBLIC ENl1TY PRIOR TO <br />ENTERING INTO A CON1RA(,"T IN L~CESS OF TIm TIIRESHOID AMOUNT PROVlDIID IN SECITON <br />287.017, FLOJHDA STATUTES. FOR CATEGORY TWO 01" ANY CHANGE TN TIll L.'lFOR.l\1ATION <br />CONTAINED lNniIs FORM. .~ <br /> <br />// f~.~ <br /> <br />[signa~ ,- <br />,/ <br />AU. <br /> <br />Personally known <br /> <br />Swom to illld 9ubscrihed before me this. 20TH <br />~-- <br /> <br />day of <br /> <br /> <br />My commission ('.xpires <br /> <br />r:::- /0 It-{ 01'/.)- <br /> <br />. <br /> <br />II '-I';;;-d~ <br /> <br />OR Produced identification <br /> <br />(Type of identification) <br /> <br />Form PUR 7068 (Rev.06/11/92) <br /> <br />(printed, type::u or stamped commissioned <br />name Ofllotary public) <br /> <br />"t:-'''\''J,l!'.", Donna Rndisnl. <br />!~V~nn#I!)rsttf1 <br />szt .i= BJ:pIres lfav. 12. 2C(5 <br />-;..; ~ -s.$ ~ Tbnl <br />..,,'1'~f\~" A"~. n.-4:..^ Co. In:. <br />",,,,,,,.,,, ~l.I..k I.Junu.u..lfi I <br /> <br />14 <br /> <br />SIB <br />