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oR_SV14NY IS���e <br />9 <br />FLOS 6�r <br />SUN <br />STATE OF FLORIDA ) <br />COUNTY OFhatk) <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 />The foregoing <br />Do&L-y'T <br />of versonl. as <br />executed]. <br />i <br />y. <br />instrument wat_,,acknowledged before me this day of <br />20�, by - �f20 Ella n44k l [name <br />)_T, m— V, P&1361 - [type of authority], for <br />S6r-- [name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />,�" Iii�aaa <br />�, �Mra�w�ona�eoedna� <br />°' Coma�hebn Noy 00 p10t87' <br />Notary Pu li -State of Florida <br />alh!)dR12 J::_(2l:EEn44Q <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification ✓ <br />Type of Identification Produced 94(?-) i0A DM iEota_ Lt I c -Os <br />DECEMBER 28, 2010 <br />