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S <br /> k SONN�-.s,E+ <br /> ® = „ ,, ANTI — KICKBACK <br /> 1 x <br /> • City of Sunny Isles Beach <br /> �+- 18070 Collins Avenue <br /> ® '. .'•.ions Sunny Isles Beach,FL 33160 <br /> '.v.1v+' Telephone:(305)947-0606 Faz(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ® COUNTY OF KG(e__) <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. n <br /> ® By: 1-51-he r C{ f f Ct <br /> ® A C <br /> Title: runt itlG(G71� 1 er' <br /> ® <br /> 410 / V <br /> • The foregoing instrument was acknowledged before me this °i"" day of <br /> ® , 20/ Z , by s -4 e [name <br /> of person], as [type of authority], for <br /> [name of party on behalf of whom instrument was <br /> • executed]. <br /> • <br /> • AFFIX NOTARY STAMP HERE: <br /> FRANKLINRODRIOUEZ • • • ry Publi State of Florida <br /> At Cc nissic,Sole of Flory <br /> S:.$ Cc-tmissionl 00676732 <br /> ® !iv wool. e+pires Porn 1, 2013 �//n l 6re-, <br /> Print or Type Commissioned Name <br /> ® Personally Known OR Produced Identification /1- <br /> • Type of Identification Produced ,FL 2/ <br /> fb <br /> i <br /> • <br /> ® DECELOER 28.2010 7 of 7 <br /> S <br /> S <br />