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STATE OF FLORIDA ) <br />COUNTY OF <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: e — ��- t r 1 c;4cnv <br />Title: C J.) G <br />The foregoing instrument was acknowledged before me this a7'0' day of <br />�D• 1 20 -IL, by (3Cvt 7 f [name <br />of person], as C '(3 .0. [type of authority], for <br />V—l.o 6` \vv -s , c®c-. U.0 [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Notary ubc "—ate of Florida <br />Prin�ype Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />1PPY P`d <br />r� <br />TAYLOR STADLER <br />Commission #GG 96646 <br />m., <br />Commission Expires 0447.2021 <br />Bonded Through - Cynanotary <br />Florida - Notary Public <br />Notary ubc "—ate of Florida <br />Prin�ype Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />