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STATE OF FLORIDA ) <br />COUNTY OF DAH. ) <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: doA4M- y"A-'- <br />Title: �iI' r� J�L�J Xy �a,rv� (0ro• <br />v4'rjhe foregoing instrument was cknowledged before me this IL day of <br />20� by �DS%uh CG [name <br />of person], as / ircF. w— o0 SA&t5 • [type of authority], for <br />' G M [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />ov °gib Notary Pubic <br />. �; State of Ronda <br />CnrjWm Ni FF 16548 <br />l e'd CA , <br />Notary Publi —State of Florida- <br />Print or Type Commissionbd Name <br />Personally Known OR Produced Identification 1� <br />Type of Identification Produced gVt#," fit. Celt. !-C . <br />DECEMBER 28, 2010 7 of 10 <br />