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STATE OF FLORIDA ) <br />COUNTY OF OKA W69)) <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br />will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br />by an officer of the corporation. <br />The foregoing <br />Nt)&t�T , <br />of personl, as -A <br />executed]. <br />By: <br />Title: 6'2 .. Aft' AL <br />instrument was acknowledged before me this day of <br />202, by , t7© FREtrwAk) [name <br />)()Tr+(Z % P1)/3o/_ [type of authority], for <br />S11lu= rname of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />IMI NeQ WNW <br />� �r My eaTM+lr�on oar.. o <br />Qommla M Na QQ 910167 <br />Notary Pu li — State of Florida <br />F U:(+919 <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced (?j1)4 't>MOE s Li i GOSE <br />DECEMBER 28, 2010 <br />