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(11-11-02) Civil Engineering Services to Design Street & Drainage Improvements
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Last modified
2/9/2012 11:08:58 AM
Creation date
2/9/2012 11:06:16 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Civil Engineering Svcs.
Bid No. (xx-xx-xx)
11-11-02
Project Type (Bid, RFP, RFQ)
Bid
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<br />1 <br />rl <br />rl <br />~l <br />~l <br />] <br />: I <br />~ I <br />\ : I <br />I ' \ <br />Il <br />\ ~ I <br /> <br />I <br />I <br /> <br />I I <br />, J <br />I <br /> <br />, , I <br /> <br />I 1 <br />I <br /> <br />, j <br /> <br />r I <br />I <br /> <br />, j <br /> <br />, J <br /> <br />I I <br />,. I <br /> <br />I ' <br />I <br /> <br />I <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 />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 indirectly by me or any member of my firm or <br />by an officer of the corporation. <br /> <br />By: <br /> <br />-~ <br /> <br />Title: <br /> <br />President <br /> <br />day of <br />[name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />The foregoing instrument was acknowledged before me this <br />November , 20~, by Jose A. Gonzalez <br />of person], as President <br />CIMA EnQineerinQ Corp <br />executed]. <br /> <br />29 <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />....;,':t-.~.r!J."'" VIVIANA V1NDEL <br />!*~. ~~ MY COMMISSION # EE 137264 <br />~" EXPIRES: October 11, 2015 <br />-"r. .., Bonded Thru Notary Public Underwriters <br /> <br />Viviana Vindel <br />Print or Type Commissioned Name <br /> <br /> <br />Personally Known X OR Produced Identification <br />Type of Identification Produced <br /> <br />7 of 7 <br /> <br />DECEMBER 28, 2010 <br />
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