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O�SVN <br />Ff�. _ <br />i` f� <br />f DDS. <br />FL V_ bit <br />C�Tr.OF SUN 1a <br />STATE OF FLO DA) <br />COUNTY OF c AA <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 />Allan E Alcerro <br />Title: Store Manager <br />The foregoing instrument wa acknowledged before me this b day of <br />Q4 4 20 a by Q- >� �fhl.akd a�1 1�,[� [name <br />of pers ], as Allan E Alcerro [type of authority], for <br />The Goodyear Tire & Rubber Company store #2556 [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />4 MMOUCHEM LAFORI UNE FELDC <br />Notary Public <br />0 12 c State of Florida <br />W NCE 1��r Comm# HH176908 <br />Expires 9/20/2025 <br />�Ltiv &ko.- Z. 1 ""WAJ& <br />& <br />N tart' Public — State 80 Florida <br />0 ark K A ./ A 'Hr)R 'io 4 -b" WGI,, <br />Print or Type Commissioned Name <br />Personally Known OR Produced I eptificationl/ <br />Type of Identification Produced 0)Ws— 14—LI)C)J— 0 <br />DECEMBER 28, 2010 <br />