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(11-04-03) Stormwater Catch Basin Cleaning
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Select Environmental Services
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Last modified
9/10/2015 9:52:11 AM
Creation date
5/26/2011 11:02:16 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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��ar�war is <F. <br />, <br />,e <br />f f'L.DR <br />C <br />STATE OF FLORIDA ) <br />COUNTY OF Hillsborough <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. <br />The foregoing instrument <br />May ' 2011 , by <br />of person], as Asst. Vice President <br />Select Environmental Services, Inc. <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />r RIKI COURTMAN <br />MY COMMISSION #DD956249 <br />EXPIRES: JAN 27, 2014 <br />a^ Bonded through 1st State Insurance <br />Personally Known xx <br />Type of Identification Produced <br />By: <br />Title: Asst. Vice President <br />was acknowledged before me this 23rd day of <br />Ryan Perez [name <br />[name of party on <br />[type of authority], for <br />behalf of whom instrument was <br />Notky Public — State of Florida <br />Riki Courtman <br />Print or Type Commissioned Name <br />OR Produced Identification <br />n/a <br />DECEMBER 28, 2010 7 of 7 <br />
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