Laserfiche WebLink
SJ$N Y'S<F� <br /> C1‘ B <br /> y ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> , 18070 Collins Avenue <br /> c 01- <br /> '/• <br /> - <br /> ' •F L O° yap Sunny Isles Beach,FL 33160 <br /> or suo P'N Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE @FSB' ) <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 /> Towan Isom • <br /> Title: President/CEO <br /> The foregoing instrument was acknowledged before me this 30 day of <br /> Oof o , 20 1 , by r,)CLA So(v1 [name <br /> of person], as .P r e s [type of authority], for <br /> Ii con\ l o 1 S ('ke ie .1 (name of party on behalf of whom instrument was <br /> executed]. • <br /> AFFIX NOTARY STAMP HERE: <br /> • <br /> Notary Public— State of-Florida- Ma((1k N/ <br /> _ spa YYDS <br /> Print or Type Commissioned Name <br /> Personally Known K OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 28,2010 7 of 10 <br />