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SJ$NY,s‘6 <br /> a. <br /> P- = r)" T, ANTI - KICKBACK <br /> C ..''''0. <br /> ~ • • City of Sunny Isles Beach <br /> " •'a i' "' 18070 Collins Avenue <br /> y O <br /> ' c'99 o:f O%uS'No`s Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF BROWARD ) <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 i <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. i <br /> By: JUSTEN SHIFF %C_--- <br /> Title: PRESIDENT <br /> 0 The foregoing instrument was acknowledged before me this 6 day of <br /> MAY , 20. 19 , by JUSTEN SHIFF [name <br /> of person], as PRFSIDFNT [type of authority], for <br /> SHIFF CONSTRUCTION& DEVELOPMENT [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> % % RIA Q.PICONE Nota Public— State of Florida <br /> ,..,,,g' ,,,,, <br /> �i. •• MY COMMISSION+#GG 015375 <br /> �ir�r <br /> .•���•� EXPIRES:September 8,2020• RIA Q. PICONE <br /> %',o,:,,,,,. Bonded Thru Notary Public Underwriters Print or Type Commissioned Name <br /> • <br /> Personally Known X OR Produced Identification <br /> Type of Identification Produced <br /> a <br /> DECEMBER 28,2010 7 of 8 <br />