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S�KNr rs< <br />n U. _ <br />a <br />yfos?`PLO ov`¢ <br />art OF SUµ P� <br />STATE OF FLORIDA ) <br />COUNTY OF "b (YO-_�— ) <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 />Theo -A <br />}u , <br />of person], as _ <br />executed]. <br />Title: <br />instrument was a <br />29 by :� N <br />AFFIX NOTARY STAMP HERE: <br />;'i'PY'iis., <br />MENET M 2ARRA <br />?°�;_. Notary PLoiic - State of Florida <br />'•�',,, 55��,,,o` Commission # HH 182420 <br />o°` My Comm. Expires Oct 6, 2025 <br />8oneed through National Notary Assn. <br />l <br />ged before me this <br />C11ZM <br />C4-0 C [type of <br />[name of party on behalf of whom <br />3 0 day of <br />[name <br />authority], for <br />instrument was <br />ry Public — State of Florida <br />kf M par -La. <br />Print or Type Commissioned Name <br />Personally Known �`�— OR Produced Identification <br />Type of Identification Produced _ L) <br />DECEMBER28,2010 <br />