HomeMy WebLinkAboutAttachment KAfl-i.il1-L.9LrCOL6".'TJ', FL On""IDA
ATTAOIENT
_AFFIDAVIT OF MIAI II -D -ADE COU'�T�'
LOEBYjST' REGISTR-ATI ON FUR ORAL PRESENTATIO\
(1) Prc�ecu,fle:
(2) DeG3—Ti Tte,nt:
(3) FLM�Proposer's Nam e: _
Add, ess:
Eusincss Telephone. ��
Prot e:Ci, O.:
(d) List All Members of the Presentation Team Who Will Be Participating in the Oral Presentation:
1d,41,iE TITLE EMPLOYED BY TEL. NO.
(ATTACH ADDITIONAL SHEET IF NECESSARY)
The individuals named above are Registered and the Registration Fee is not required for the Oral Presentation ONLY.
Proposers are advised that any individual substituted for or added to the presentation team after submittal of the proposal
and filling by staff, MUST re,ister with the Cle,-k of the Board and pay all applicable fees.
a
Oilier than for the oral presentation, Proposers who wish to address the county coninissicn, a count), board or county
committee concerning any action, decision or reco=cndation of county personnel regarding this solicitation MUST
register with the Clerk of the Board (Form BCCFORM2DOC) and pay all applicable fees. .
I do solerrLnly swear that all the foregoing facts are true and correct and I have read or am familiar with the provisions of
Section 2-1 1.I (s) of the Code of Nletropolkan Dade County as amended.
Sic"nature of Authorized Representative:
Title:
STATE OF _
COUNTY OF
The foregoing instrument was aclmowledgecl before me this
by , a
(Individual, Officer, Partner or Agent)
to me or N},ho has produced
Signature of person taking acknowledgement)
(Name of A6-govdedzU typed, printed or starnpcd)
(Title or RarJ:) (Serial Nurnber, if any)
) who is personally kno4vn
(Sole Proprietor, Corporation or Partnership)
as idcntification and rho did/did not take an oath.