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VNNY /5< <br />OF d <br />� F <br />V I <br />a Pa <br />F "L O � Swc <br />TY Ot' SUN P� <br />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 <br />• <br />q The foregoing instrument was acknowledged before me this `l da of <br />, 20 al , by C� S zk1a�-vL� [name <br />of person], as '��t�i eJ��,��- [type of authority], for <br />kha.l) [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP H <br />P BRITT -BAILEY <br />04My <br />Notary Public - State of Florida <br />Commission N GG 356712023 Comm. Expires Nov 16, <br />Bonded through National Notary Assn <br />Notary• - o", <br />rrida <br />C`ck �_'�.�ct_v <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced wecz5 �c�%fnL=R- <br />7 of 12 <br />