HomeMy WebLinkAboutAttachment KA L-1 f!-D.4DE COUNTY, FLORID 4
(1) ProjectTitle:
(2) Department:
ATTAGHMENK
AFFIDAVIT OF ItiIIAi11I-DADS COUNTY
LOBLI IST REGISTRATION FOR ORAL PRISENT.ATION
Proj ectNo.:
(3) Firrn. Proposer's Name:
Address:
Business Telephone: ( )
Gip:
(4) List All Members of the Presentation Team Who Will Be Participating in the Oral Presentation:
NAME TITLE
EMPLOYED BY TEL.NO.
(ATTACH ADDITIONAL SHEET IF NECESSARY)
The individuals named above are Registered and the Registration Feeds 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 register with the Clerk of the Board and pay all applicable fees.
Other than for the oral presentation, Proposers who wish to address the county commission, a county board or county
committee concerning any action, decision or recommendation of county personnel regarding this solicitation MUST
register with the Clerk of the Board (Form BCCFORM2DOC) and pay all applicable fees,
I do solemnly swear that all the foregoing facts are true and correct and 1 have read or am familiar with the provisions of
Section 2-11.I (5) of the Code of Metropolitan Dade County as amended.
Signature of Authorized Representative:
Title:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me
by ,a
(Individual, Officer, Partner or Agent)
to me or who has produced
this
, who is personally known
(Sole Proprietor, Corporation or Partnership)
as identification and who did/did not take an oath.
.Signature of person taking acknowledgement)
(Narne of Acknowledger typed, printed or stamped)
(Title or Rank) (Serial Number, if any)
,4 • Rrv. I/ /93