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RFP No. 11-08-01 Property & Casualty Comprehensive Insurance
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Fl. League of Cities, Inc.
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Last modified
8/23/2011 11:32:35 AM
Creation date
8/23/2011 11:31:59 AM
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CityClerk-Bids_RFP_RFQ
Project Name
Property Casualty Comp. Insurance
Bid No. (xx-xx-xx)
11-08-01
Project Type (Bid, RFP, RFQ)
RFP
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<br />" <br /> <br />c <br /> <br />c <br /> <br /> <br />ANTI-KICKBACK <br /> <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 /> <br />Of ,>tJ~ <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br /> <br />) <br />) <br />) <br /> <br />COUNTY OF Orange <br /> <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 /> <br />By: <br /> <br />/Jt~~/EACf <br /> <br />Un erwntmg Manager <br /> <br />Title: <br /> <br />~The foregoing instrument was acknowledged before me this Id-CAC day of <br />~~ , 20~, by ~t~/\vY\ G~nrv-~ , [name <br />of p rson], as ~hAAAllA )-(~ ~"'- . [type of authority], for <br />'-\-lcu-<u~ ~vJ.. ot G.J0:L~ [n me of party on behalf of whom instrument was <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />&JJ~ ~O.l1~ <br />Notary Public - State of Florida <br /> <br />t~e~AeA- f\. m ~i--hel~)sc)N <br />Print or Type Commissioned Name <br /> <br />- - - <br /> <br />I ",~;';;~I::::l" BARBARA D. MATHEWSON <br />{+m. .:-b\ Notary Public - State 01 Florida <br />. ~'. · . ~ My Comm. Expires Jul 20 2013 <br />, ~-t:"i^_ (t;~'~i Commission (I DO 874050 <br />'41 I, ...... f\; " <br />",..."" 80nded Through National Notary Assn. <br /> <br />Personally Known ~ OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />
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