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(11-11-02) Civil Engineering Services to Design Street & Drainage Improvements
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Last modified
6/20/2012 12:05:29 PM
Creation date
2/9/2012 3:46:27 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Civil Engineering Svcs
Bid No. (xx-xx-xx)
11-11-02
Project Type (Bid, RFP, RFQ)
RFQ
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OF SVµNY I st Ff <br />0 yFr <br />c�rY of su�'0Q <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. <br />By: Miguel Mondria, PhD <br />Title: President <br />The foregoing instrument was acknowledged before me this 1st day of <br />December , 20 11 , by Miguel Mondria PhD <br />of person], as President [name <br />Beiswenaer Hoch &Associates Inc [type of authority], for <br />executed]. [name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />LJNDA S. SCOTE732( <br />MY COMMISSION # EE = EXPIRES [)scamper 115 <br />Bonded Thru Notary Public urilers <br />_. C�4 �- 2�i� <br />Not ry Public — State of Florida <br />Linda S. Scotece <br />Print or Type Commissioned Name <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 Of 7 <br />
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