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S ,o41y v* t <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />•,, �� 4t• <br />`'r '° ��� <br />18070 CollinsAvenue <br />• � � o�, <br />Sunny l:les Beach. FL. 33160 <br />c rr er i. w,10 <br />rekephon4. 1309j 947-Q600 Fav4305} 949-Sl13 <br />- ANTI -KICKBACK AFFIDAVIT <br />STATE OF FLORIDA <br />COUNTY OF MilG6 ()gCLU ) <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 etectec officialis 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 />Title: i <br />The foregoing instrument was acknowledged before me this day of <br />0 by [name <br />of person], as [type of authorityl, for <br />[ ame of party can behalf of whom_ instrument was <br />executed]. <br />AFFIX NOTARY SWAMP HERE: <br />dp""t�, 14ASHATH MOMES <br />MY CQmMMIC N 4 Ff17MI <br />�� �iNFS�M�35,20Z0 <br />N04N k2b+iic ---Shte Of FBorlda <br />M D P-Pr e'5. <br />Print or Type Commissioned Fume <br />Personally Known_ OR Produced Identification <br />Type of Identification Produced <br />7 a110 <br />