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Right Choice Vending/Coffee
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RFP No. 17-03-01 Citywide Healthy Vending Machine Services
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Right Choice Vending/Coffee
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Last modified
4/7/2017 3:13:06 PM
Creation date
4/7/2017 3:12:47 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Citywide Healthy Vending Machine Services
Bid No. (xx-xx-xx)
17-03-01
Project Type (Bid, RFP, RFQ)
RFP
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SV$NY,S,F <br /> • <br /> _c-'' ~fie n <br /> ANTI - KICKBACK <br /> fil ,, ' �. 4 . <br /> - City of Sunny Isles Beach <br /> 9 = ;__- r 18070 Collins Avenue <br /> s'E ''•c L V a\OG+` Sunny Isles Beach,FL 33160 <br /> f of sus�` Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF PJ CLAW ) <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: A44-- <br /> las)a exz.77 'H L ft.LE.LT <br /> Title: ---D\`a_�- c (L DF-- OPe�PtRos <br /> • <br /> 0 A The foregoing instrument was acknowledged before me this 6 day of <br /> ieLle^( , 20 I l by (Lcc - c Irk L L..L [name <br /> of person], as 'D t.rL --‘1:›v _ CV cie ziz.peKN_ 'iS [type of authority], for <br /> tk Gm'T C.AA o 1 c_-E. v tc _ t , [name of party on behalf of whom instrument was <br /> executed]. k STACEY C SNEDIKER <br /> ' MY COMMISSION#GG028051 <br /> AFFIX NOTARY STAMP HERE: '''ra.•;:• EXPIRES September 08,2020 <br /> Notary Public—State of Florida <br /> (54c`-C`(?( sJ t-( ' <br /> Print or Type Cmmissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> • <br /> 7of7 <br />
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