Loading...
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