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IS< <br /> Co <br /> ANTI - KICKBACK <br /> ' •• City of Sunny Isles Beach <br /> r; 18070 Collins Avenue <br /> Qv- <br /> 91°f l OP° Sunny Isles Beach,FL 33160 <br /> Of %VN Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF MI ) <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: CLQ /0 <br /> Title: ?c6( O <br /> The foregoing instrument was acknowledged before me this I day of <br /> 1/14Arc t.. , 20 14 , 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 /> .► ► ;: <br /> Notary Public — S e of Florida <br /> Ammo LARREA <br /> :.• ti; W COMMISSION A Cats 283153 <br /> =�x P EXPIRES:December 11,2022 <br /> .Q,'rF• f Bonded"(Wu Notary Pubic Mode s <br /> Print ype Commissioned Name <br /> Personally Known OR Produced Identification <br /> 'type of Identification Produced <br /> DECEMBER 28,2010 <br />