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Tally Engineering, Inc.
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(11-07-01) Special Inspection Svcs, including Geotechnical/Const. Admin.
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Tally Engineering, Inc.
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Last modified
8/30/2011 2:27:13 PM
Creation date
8/30/2011 2:26:27 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Special Inspection Svcs including Geotechnical
Bid No. (xx-xx-xx)
11-07-01
Project Type (Bid, RFP, RFQ)
RFQ
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<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 />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF Broward ) <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 indir by me or an member of my firm or <br />by an officer of the corporation. <br /> <br />By: <br /> <br /> <br /> <br />Title: President <br /> <br />The foregoing instrument was acknowledged before me this <br />, 20~ by Pirooz Borojerdi <br />President <br /> <br />July <br />of person], as <br />Tally Engineering, Inc. <br />executed] . <br /> <br />day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br /> <br />14 <br /> <br />[name of party on <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />.~'f~., MARILYN MEDINA <br />fo/"l1.'\E MY COMMISSION HE 029888 <br />~~.~ EXPIRES: September 27,2014 <br />"I'i.P.f..~' Bonded Thru Nolay Public Underwrllets <br /> <br />Marilyn Medina <br />Print or Type Commissioned Name <br /> <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />
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