HomeMy WebLinkAboutLocation Affidavit4.6. OFFICE LOCATION AFFIDAVIT
Please type or print clearly. 'Phis Affidavit must be completed in full, signed and notarized ONLY if your office is located within the
corporate limits of the City of Miami.
Legal Name of Firm:
Er ti Ity `1 ype: (chock one box only) [] Partnership
[] Sole Proprietorship :Corporation
Corporati Doc, No: Date Established:
(.3 Lig rT (2 C` 3
M F.l 4i k'd� c � U,e4 �+ � 4 P t.•.. ! '� b S" ff i.'
r., ,,,: ;,:'., 7fii�l„ oeati`e1natlitltjdttltotio's'
PRESEN"!
Street Address: itr. C' 11
City: I?CC`¢V State:
Occupational License No:
Date of Issuance:
20ar 1 3' i ] 9•-- r('( t/
R
l3E°r1S�'+,$.M0�.�i,E,
How long at this location:
PREVIOUS
Street Address, ,:jt
City: /71C(-,,41' State —�
According to Ordinance No. 12271 (Section 18-8.5):
How long at this location:
The City Commission may offer to a responsible and responsive local bidder, who maintains a Local Office, the opportunity of accepting a bid at
the low hid amount, if the original bid amount submitted by the local vendor itiLot more than tonsercent _Etna in exctis of the lowest other
responsible and responsive bidder_
The intention of this section is to benefit local bona fide bidders/proposers 10 promote economic development within the corporate limits
of the City of Miami,
(we) certify, under penalty of perjury, that the office location of our firm has not,,been eyk blished with the sole purpose, of obtaining the
advantage granted bona fide local bidders/proposers by this section.
Authorize Signature
�rl�j`14•
f' nit
Nam7 e .. _
.•, , 1 s .
Title
Authorize Signature
Print Name
Title
(Must be signed by the corporate secretary of a Corporation or one general partner of a partnership or the proprietor of a sole proprietorship or all
partners of a joint venture,)
STATE OF FLORIDA, COUNTY OF DADE
Subscribed and Sworn before me that this is a true statement this --- L / day of '�.1 Gt i
1 1�� tt
NotaryPublic State of Florida MyComm fission expires
r � P
I1
i I C...rtt'.'i11 C_:f r,v't_>.y-.
Printed name of Notary Public
i LI
[t}•C ersonal ly known to me; or
:
Ina ii produced identification:
l'ITOTUN 171 , tt rA l,l'. OF FLORIDA
V1 (51.ori.i C ifVet,'
i;rxrrItr]`iIts', i't r,'•'Da729a'1
E!:lsir; s: NOV 17, 2001
FSnrtr_Ld'Tfurr.l'au.rit'i4 Co,,'1rie,
Please submit with your bid copies of Occupational License, professional and/or trade License to verify local status. The City of Miami
also reserves the right to request a copy of the corporate charter, corporate income tax filing return and any other documents(s) to verify
the location of the first's office,
City of Miami Page 33
Bid No. 05-66-006