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. <br /> iN�Y isfs <br /> jto <br /> ° ANTI - KICKBACK <br /> 5. <br /> • \1- City of Sunny Isles Beach <br /> • 18070 Collins Avenue <br /> a� D'�•r�a�' y�c Sunny Isles Beach,FL 33160 <br /> c,r or sus P•4° <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF <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 m firm or <br /> by an officer of the corporation. <br /> By: LW ,4 <br /> Title: J2� 19 c-8-J <br /> V <br /> The foregoing instrument was acknowledged before me this OG day of <br /> 20 21) , by, Lob a • 0 t4 ti-A9 [name <br /> of person], ast-gam i ) e.T [type of authority], for <br /> 7 ,O-1i zS [•(.C[name of party on behalf of whom instrument was <br /> executed <br /> AFFIX NOTARY STA - 4' potary Public State Florida <br /> • Javier Perez Ayala924496 <br /> .. My Commission <br /> • .•tary Public—State of Florida <br /> • <br /> 3-41'�1 1��L. �>i1�rJ� A-14.1-4- <br /> Print <br /> - 4.1-q- <br /> Print or Type Commissioned Name <br /> Personally Known ?(... OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 28,2010 7 of 8 <br />