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) <br /> <br /> <br />ANTI-KICKBACK <br /> <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 /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF Broward ) <br /> <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 /> <br />By: <br /> <br />Peter Moore, P.E., LEED(4 <br /> <br /> <br />Title: President <br /> <br />\ <br />! <br /> <br />The foregoing instrument <br />April , 20---.1f.., by <br />of person], as President <br />Chen Moore and Associates <br />executed] . <br /> <br />was acknowledged before me this <br />Peter Moore. P.E.. LEED AP <br /> <br />30 day of <br />[name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />NOTARY PUBLIC-STATE OF FLORIDA <br />.............. Kathryn J. Horrigan <br />g W ~ Commission # DD997048 <br />~.~,/ Expires: JUNE 01, 2014 <br />BO;mE~ THRU tlTLiI!iTlC BONDING CO,. INC, <br /> <br /> <br />cV\- <br /> <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br /> <br />CHI~RE <br />&ASSOCIATIS <br /> <br />lira No, 1l-04-04 Desigll a/l/I /Jermillillg Services o{llre Inlramllstal f'arks 7-11 <br />