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SUNNY is< <br /> Q ....gin-. J <br /> ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> s•a��°' ‘c. <br /> 4� 18070 Collins Avenue <br /> `c, F 120. ' Sunny Isles Beach,FL 33160 <br /> of sus.+ Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF 14-4 ) <br /> COUNTY OF Cc—vvp sok ) <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: fed-t• <br /> Title: p <br /> The foregoing instrument was acknowledged before me this 12, day of <br /> ntatl , 20 1 ?, by lo6,. SGS ccer [name <br /> of person], as ciA;g-S,- gr.a ;a` ai [type of authority], for <br /> Sv -4 41•k 7,1� [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public— State of r W-c, <br /> g757-46( <br /> Print or Type Commissioned Name <br /> Personally Known X- OR Produced Identification ISTAU <br /> NOTARY PUBLIC <br /> Type of Identification Produced Kentucky,State At Large <br /> I.D./543406 <br /> • My Commission Expire 10!1/2019 <br /> 7 of 7 <br />