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Shenandoah General Construction Co.
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(11-04-03) Stormwater Catch Basin Cleaning
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Shenandoah General Construction Co.
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Last modified
9/10/2015 9:52:50 AM
Creation date
5/26/2011 10:43:10 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Storm Water Catch Basin Cleaning
Bid No. (xx-xx-xx)
11-04-03
Project Type (Bid, RFP, RFQ)
Bid
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O� SuNNY. +St ifs <br />a. F <br />7 <br />n <br />• P <br />if ADD) • F`O0.`Q y�e <br />C, N� <br />1y Or Su" <br />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 -0606 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. /-,\ n <br />By: — V <br />Title: <br />Daniel DiMura, vice President <br />The foregoing instrument was acknowledged <br />May 20 11 1 by Daniel DiMura <br />Of person], as vice President <br />Shenandoah General Construction Cc <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />NOTARY PUBLIC-STATE OF FLORIDA <br />Margaret A. Lary <br />Commission # EE043408 <br />'•off',•` Expires: DEC. 09, 2014 <br />BONDED THRU ATLANTIC BONDING CO,, INC. <br />before <br />[name of party on <br />Margaret <br />Print or Tv[ <br />Personally Known X OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 Of 7 <br />me this 24 day of <br />[name <br />[type of authority], for <br />ilf of whom instrument was <br />orida <br />Name <br />
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