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122 <br />SECTION H Forms and Attachments <br />RFQ # 21-11-01 PROFESSIONAL PLANNING AND ZONING CONSULTING SERVICES, CIVIL AND TRAFFIC ENGIEERING <br />7 of 8 <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 />STATE OF FLORIDA ) <br />) <br />COUNTY OF ___________ ) <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: ________________________________ <br />The foregoing instrument was acknowledged before me this _____ day of <br />__________________, 20____, by _________________________________________ [name <br />of person], as __________________________________ [type of authority], for <br />________________________________ [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />_______________________________ <br />Notary Public – State of Florida <br />________________________________ <br />Print or Type Commissioned Name <br />Personally Known __________ OR Produced Identification __________ <br />Type of Identification Produced ________________________________ <br />Miami-Dade <br />Joseph M. Corradino, AICP <br />President <br />17th <br />November 21 Joseph M. Corradino, AICP <br />President <br />The Corradino Group, Inc. <br />Maria Elena Shepherd <br />X