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III \ /BV rINY 112E <br />O n <br />V Z <br />!r Or 4VN <br />STATE OF FLORIDA ) <br />COUNTY OF Orange ) <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 />Jay J ck n, <br />Title: Senior Vice President/Principal <br />The foregoing instrument was acknowledged before me this 11th day of <br />August , 20 14 , by Jay Jackson, P.E. [name <br />of person], as Senior Vice President/Principal [type of authority], for <br />Kimley -Horn and Associates. Inc. [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />X4.)Notary Pudic State or Fbr cla <br />Chartene Kurlold <br />My Commission FF 093962 <br />Expires 02/19/5018 <br />Notary Public — State of Florida <br />Cfffgc�imr KUgocc) <br />Print or Type Commissioned Name <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br />DECE BER 28.2010 <br />RFQ 14 -07 -02 <br />Kimlec -Horn <br />6 -14 <br />