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S,µNY/sq.. <br /> ANTI - KICKBACK <br /> ZCity of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> '",:s.5•F I OA �'� Sunny Isles Beach,FL 33160 <br /> os sus' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <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: �'ei (OGyu " <br /> The foregoing instrument was acknowledged before me this ( day of <br /> kE g yke. y , 20/ T , 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 /> L7\ <br /> MARIA SERVAT <br /> NOTARY PUBUC Notary Public — State of Florida <br /> STATE OF FLORIDA <br /> •ogg t;-� Comm*FF010503 H A 2! 41.. e--7-1.) Ch <br /> >" ' Expires 5/312017 <br /> Print or Type Commissioned Name <br /> Personally Known--------' OR Produced Identification <br /> -Type-Cif Identification Produced <br /> DECEMBER 28,2010 7 of 7 <br />