HomeMy WebLinkAboutanti-kickback_form_sparcSTATE OFA )
COUNTY OF •1 DZ- )
ANTI -KICKBACK.
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
ANTI -KICKBACK AFFIDAVIT
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By: Richard Cassis
Title: President
The foregoing instrument was acknowledged before me this
ust 2019 by Richard Cassis
of person], as President
Sparc Design, Inc.
executed].
[type
[name of party on behalf of
of
whom
9th day of
[name
authority], for
instrument was
AFFIX NOTARY STAMP HERE:
Notary Public — State of -Fluidal-
NATASA SAS IC
Official Seal �/W/T0— S f13/c
Notary Public— State of Illinois ��'I
My Commission Expires Jan 4, 2022 Print or Type Commissioned Name
Personally Known 1/ OR Produced Identification
Type of Identification Produced
DECEMBER 28, 2010