HomeMy WebLinkAboutattachmentEPREVIOUS CONTRACT NO. H-5-01-09Q-B1 BID NO. H-9-Q3.242.61
ATTACHMENT "E"
FORM OF CERTIFICATE AND AFFIDAVIT
FOR BONDS UNDER $500.000.00
TO: BOARD OF COUNTY COMMISSIONERS OF BROWARD COUNTY
RE: BID NUMBER
BIDDER NAME
ADDRESS
PHONE
AMOUNT OF BOND
SURETY BOND
COMPANY
NAME
ADDRESS
PHONE '
This is to certify that, in accordance with Chapter 85-104, Laws of Florida (HB1266), the insurer named above:
Holds a certificate of authority authorizing it to write surety bonds in Florida.
Has twice the minimum surplus and capital required by the Florida insurance Code.
Holds a currently valid certificate of authority issued by the United States Department of Treasury under Section 9304 to
9308 of Title 31 of the United States Code.
AFFIDAVIT
Agent and Attorney -in -Fact
Date Signed
STATE OF FLORIDA )
COUNTY OF )SS
Before me this day personally appeared , Chief Financial Officer of , who, being duly
sworn, executed the foregoing instrument and acknowledged to and before me the truthfulness and accuracy of the
statements in the foregoing instrument.
Signature of person making Affidavit
SWORN TO AND SUBSCRIBED before me this day of , 2004
Notary Public, State, State of Florida
My Commission Expires:
RMIRS-PBO9-2003