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%4 NY I.Tt <br />a. F <br />C'rr OF SUN\�V <br />STATE OF FLORIDA ) <br />COUNTY OFWtfl) <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 />N)&Lo�'T <br />of Dersonl. as J <br />executed]. <br />instrument was acknowledged before me this day of <br />202Q, byj?-ta.21F��� X72 -r_rvlA0 (name <br />) t)Ti w \,- -PwSL:i/_ [type of authority), for <br />\SJ;E=- [name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />010Z l9ew.raar►Wn,M <br />SWeelft <br />Mremomb 80"ONVAM <br />a own"MNa0*910187 <br />Notary Pu li — State of Florida <br />&ZANV-12 <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced G.0Qtin4 t?M-6 `z Lt i e0S_g <br />DECEMBER28,2010 <br />