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° SJµNV Is <br /> ANTI — KICKBACK <br /> • City of Sunny Isles Beach <br /> ',9a, ` �t 18070 Collins Avenue <br /> cif z •F SUS'Ho 5 Sunny Isles Beach,FL 33160 <br /> ' o, SUS Telephone:(305)947-0606 Fax (305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF VO4,i1I D444 <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: <br /> t%Aar44 <br /> The foregoing instrument was acknowledged before me this T day of <br /> 20 1 ct , by �Yar>r P e4s-,cav e'{— [name <br /> of person], as ViC� ?re,,aidtrafi[type of authority], for <br /> [name of party on behalf of whom instrument was <br /> executed]. / <br /> AFFIX NOTARY STAMP HERE: V.—dab 1110: <br /> �Nr4:.i TRINIACOWERT . Nota Public Florida <br /> Florida <br /> ,•, '; ; MY COMMISSION#GG 046113 <br /> s*•a +. = EXPIRES:December 4,2020 1.1 C—.a <br /> N.ABonded Thru Notary Public UndeIwtters <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification ,x <br /> Type of Identification Produced fi_DL P35•Z-'1 f4— /-I—DV-1-0 <br /> L <br /> DECEMBER 28,2010 <br />