Laserfiche WebLink
SUNNY /J�6 <br />�� Jsis <br />" OPCOGy,t <br />00 'UM <br />STATE OF FLORIDA <br />COUNTY OF WSW <br />1 <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <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 />The foregoing instrument <br />60CE�" i FVZ_ . 20 (q , by <br />of person], as 2i&,c-tt2C-1�2; <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />EiSUSAN A, DIETER <br />NotaryPublic St�rlcufFlorida <br />(Ommissiona GG 18990/ <br />MyComm.Expires May 29,2022 <br />ed through Notional Notary Assn. <br />Title: 't-MAOOE-110c- <br />was acknowledged before me this Z G day of <br />[name <br />lP---) a-�arK��j�� _ [type of authority], for <br />[name of party on behalf of whom instrument was <br />Y <br />Notary Public — State of Florida <br />14. <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER28,2010 <br />