ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,…
Appears in 8 contracts
Samples: Contract for Heavy Equipment Parts and Labor, Contract for Heavy Equipment Parts, Contract for Heavy Equipment Parts and Labor
ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐☐ physical presence, or ☐☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,…
Appears in 3 contracts
Samples: Leachate Hauling and Cleaning Services Contract, Contract No. Y22 1012, Right of Way Mowing – Goldenrod Area, Section Ii, Contract for Services
