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H-14Proven solutionsResponsive and dependable performance <br />City of Sunny Isles Beach RFQ No. 20-07-01: Continuing Professional Consulting Services (CCNA) <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 />STATE OF FLORIDA ) <br /> ) <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 my firm or <br />by an officer of the corporation. <br />By: ________________________________ <br />Title: ________________________________ <br />The foregoing instrument was acknowledged before me this _____ day of <br />__________________, 20____, by _________________________________________ [name <br />of person], as __________________________________ [type of authority], for <br />________________________________ [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />_______________________________ <br />Notary Public – State of Florida <br />________________________________ <br />Print or Type Commissioned Name <br />Personally Known __________ OR Produced Identification __________ <br />Type of Identification Produced ________________________________ <br />DECEMBER 28,2010 <br />Dade <br />X <br />Owner & CEO <br />Owner & CEO <br />Lisette Marie Sierra <br />August 20 <br />14th <br />Rudy Ortiz, PE, CGC <br />Rudy Ortiz, PE, CGC <br />CES Consultants, Inc.