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STATE OF FLORIDA <br />COUNTY OF AA�e <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 />Th�� fo�egoing <br />of person], as <br />AFFIX NOTARY STAMP HERE: <br />Personally Known - <br />Type of Identification Produced <br />B <br />v: <br />Title: �/ 4 yIId 2k J <br />a knowledged before me this day of <br />[name <br />p� [type of authority], for <br />[name of party on behalf of whom instrument was <br />Notary Pub is — State of Florida <br />S11(�iLk/ U <br />eYycw-- <br />Print or Type ComrMssioned Name <br />OR Produced Identification <br />7of12 <br />��� NOI.ry Puaie stew al PIaM. <br />Sydney Herrere <br />y aF ,r <br />ExpCommnsronn�J077 <br />R d' E.. 10/04/704823 <br />