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CITY OF SUNNY ISLES BEACH <br />PARKS/MEDIANS/RIGHT-OF-WAY MAINTENANCE <br />IN THE PRESENCE OF; <br />State of — <br />County of <br />On this, the day of _ <br />Notary Public of the State of <br />(name of corporate officer), <br />corporation), a <br />corporation. <br />WITNESS my hand <br />and official sea]. <br />INSURANCE COMPANY: <br />Address: <br />Agent and Attorney -in -Fact <br />( Street) <br />(City /State /Zip Code) <br />Telephone No.: 1 <br />, 19 , before me, the undersigned <br />the foregoing instrument was acknowledged by <br />(title), of (name of <br />(state of corporation) corporation, on behalf of the <br />Notary Public, State of <br />Printed, typed or stamped name of Notary Public <br />exactly as commissioned <br />❑ Personally known to me, or <br />❑ Produced identification: <br />(type of identification produced) <br />❑ Did take an oath, or <br />❑ Did not take an oath <br />BIDDERS NAME: <br />COMPANY NAME: <br />