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O� SJNNY !S`�SB <br />V 2 <br />O r <br />'S'F =�♦ F4OR\ yo. <br />C'rY of $04 'NO <br />STATE OF FLORIDA ) <br />COUNTY OF Brnya) <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 />By: <br />Title: 7h(--, _l ►��,.P_� �,� �� f �ac.i^e�p / L' �Qr �nc.FL <br />The foregoing instrument was ackno ledged , before me this 05 day of <br />O�YuLi 20� , by tulle. Ct,+M l [name <br />of person], as [type of authority], for <br />g-MQ,— [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Isabel BelerW0 <br />(VNOTARY PUBLIC <br />STATE OF FLORIDA <br />Comn-O GG915775 <br />1,61Expires 9123/2023 <br />74Q <br />Notary c — tate of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced —VAD,( - N� S.i.C1>�.V£- <br />u•) <br />DECEMBER28.2010 n <br />