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(18-04-01) North Bay Road Drainage Improvements
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Jaffer Well Drilling
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Last modified
5/3/2018 9:28:48 AM
Creation date
5/3/2018 9:26:27 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
North Bay Road Drainage Improvements
Bid No. (xx-xx-xx)
18-04-01
Project Type (Bid, RFP, RFQ)
Bid
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o ' 4 i <br /> SUNNY rStF <br /> �� �07 ANTI - KICKBACK <br /> u11 z <br /> ...,,,,,,K.:7 <br /> _ City of Sunny Isles Beach <br /> y r 18070 Collins Avenue <br /> ' •FLO `o 9+` Sunny Isles Beach,FL 33160 <br /> r'of so*+ ''a Telephone:(305)947-0606 Fax (305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF DADE ) <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: <br /> • Title: NAJIB B HALWANI PRESIDENT <br /> The foregoing instrument was acknowledged before me this 30 day of <br /> April , 20 I g , by Moaii, NRS ux-)n' [name <br /> of I person], as Pre_Si dlpy 1 s [type of authority], for <br /> 1ae�r Well Dvi.11ir15, A '-;v;Sionn- ACS lWaMe of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> ---� - Nota ' Iic— St to of Florida <br /> ? GILVANA IE SINNING <br /> f, :: My COMMISSION#FF932886 <br /> EXPIRES November 02,2019 �,(Varna Ls-.).0/7 h��' <br /> may.-4 53 rionesnotaryServico corn Print or Type Commissioned Name <br /> Personally Known x OR Produced Identification <br /> Type of Identification Produced <br /> 7 of 10 <br />
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