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SUNNY is,e <br />s <br />� Y <br />�L0,C.a0 <br />)r FlO�`Oy,e <br />crr or sur+ hN <br />STATE OF FLORIDA ) <br />COUNTY OF����`� ) <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 />The foregoing <br />l <br />of p rson], as _ <br />executed]. <br />Title: RU3 <br />instrument was ackriowledged before m this _Z21 day of <br />20 byis�� [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />MICHELE WILSON <br />Notary Public - State of Florida <br />Commission N HH 219570 <br />lot Fv°P' My Comm. Expires May 8, 2026 <br />Bonded through National Notary Assn. <br />Notary Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known �OR Produced Identification <br />Type of Identification Produced <br />DECEMBER28,2010 <br />