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RFP No. 18-11-02 Bus Shelter Relocation and Refurbishing
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Last modified
12/11/2018 4:07:09 PM
Creation date
12/11/2018 4:05:41 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Bus Shelter Relocation and Refurbishing
Bid No. (xx-xx-xx)
18-11-02
Project Type (Bid, RFP, RFQ)
RFP
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F SJia'Y_'St`s <br /> _4- r�- ':..cn <br /> ANTI - KICKBACK <br /> �4 <br /> tCity of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> sr Sunny•r�oR'o �`' Sunny Isles Beach,FL 33160 <br /> ''''*o.$us'so Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF Broward ) <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 /> Li <br /> Title: Mehrdad Mahmoudi-President <br /> The foregoing instrument was acknowledged before me this 10th day of <br /> December r 2018 , by Mehrdad Mahmoudi [name <br /> of person], as President [type of authority], for <br /> Sagaris Corp [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> • <br /> -- > Notary Public— State of Florida <br /> HAMID FOULADI <br /> + k Notary Public=State ot.Florida <br /> • ',` •'e Commission#FF-971248 <br /> .?,s My Comm.Expires Mar.14,.2020 Print or Type Commissioned Name <br /> Personally Known X OR Produced Identification <br /> Type of Identification Produced <br /> • <br /> DECEMBER 28,2010 <br />
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