Laserfiche WebLink
<br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />; 55 <br />COUNTY OF PALM BEACH ) <br /> <br />I, the undersigned hereby duly sworn, depose and say that no portion of the sum herein bid will <br />be paid to any employees of the City of Boynton Beach as a commission, kickback, reward of <br />gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. <br /> <br />By: <~<'l~L~ <br />/ NAME 1- SI NATURE <br /> <br />Sworn and subscribed before me <br />this ~<? day of ::7 vlr <br />f <br /> <br />,20 6 'J <br /> <br />Printed Information: <br /> <br />IJ <br />;\ ' <br />~ I ,.;> /1 ... <br />NO MY PUBLIC, State of Florida <br />at Large <br /> <br />Ke,f ~t\ {J. () l Ne: ( <br />NAME <br />bevl en& {IJ1. 'i.vto. I i/ <br />TITLE <br /> <br />U;lc.. ~ )~1I't btf S'Cetf:V1 j. G.~pa.r(;..t.~ <br />COMPANY <br /> <br />~ ~ Ang!lli Wuson <br />!'~ . My commiuion DD,7103& <br />~ "Y <br />"",,,.;.J' elCpirl!ls De.cemDer 1'.2006 <br /> <br />"OFFICLAL NOTARY SEAL" STAMp. <br /> <br />88 <br />THIS PAGE TO BE SUJ3MITTED AL.ONG WITH PROPOSAL IN ORDER FOR <br />BID PACKAGE TO BE CONSIDERED COMPLETE AND ACCEPTA.BL.E <br /> <br />1;>2:/1;>1 39\;1d <br /> <br />\;I8SaN\;Il NOS aN\;I \;IlIA <br /> <br />6LBE96L199 <br /> <br />2:9:91 L002: 11;>0/2: 1 <br />