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(16-09-02) HVAC Government Center
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Koldaire
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Last modified
1/10/2017 3:03:10 PM
Creation date
1/10/2017 2:06:56 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
New HVAC Chiller Systems For Government Center
Bid No. (xx-xx-xx)
16-09-02
Project Type (Bid, RFP, RFQ)
Bid
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STATE OF FLORIDA <br />COUNTY OF Broward <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0608 Fax (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <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 />By: %f4Q21A (,PeV�J2 Frank O Mont Jr. <br />Title: President <br />The foregoing instrument was acknowledged before me this 9 day of <br />January 20J by Frank O Monti Jr. [name <br />of person], as President [type of authority], for <br />Koldaire, Inc. [name of party on behalf of whom instrument was <br />executed]. <br />y <br />AFFIX NOTARY STAMP HERE: 42 ;(�Zt <br />otaryblic — !9611:611 Florida <br />Personally Known <br />Type of Identification <br />XX <br />Produced <br />Bridgit A. Norris <br />Print or Type Commissioned Name <br />OR Produced Identification <br />BRIOGIT A. NORRIS <br />Notary Public - State of Florida �1 <br />;�'•' �`, My Comm. Expires Jul 2E, 2017 <br />Commission # FF 003858 <br />...... Bonded T^roagh National Notary Assn..J <br />oeceuernse. 2010 7 of 10 <br />
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