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• <br /> ? SV rINYrF <br /> ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> 1� 9'•FIo 'O°~`' Sunny Isles Beach,FL 33160 <br /> or Ws'''4Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF keL%4- ' �2 <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: / _ 6.4„freiw <br /> Title: <br /> — re in l ment was eledertinfa e this da of <br /> v going, 20 ! -by ` m [name <br /> of p on], as A� f/7" [type of authority], for <br /> I [name of party on behalf of whom instrument was <br /> execute J. <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public at of F (� 'da <br /> 7,/;:h9rti:::::;coLmtitslosisNpuR#: <br /> 5p /ul 4,721 <br /> �CJ ITEXPIRES:J y otal'Bonded ThnlN ry <br /> Print or Type Commissioned Name <br /> PersonallyProduced Identification <br /> Known OR I n i <br /> fication <br /> Type of Identification Produced <br /> DECEMBER 28,2010 <br />