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A. F' <br />u' x <br />F`oQ�Q t° <br />c�rr.0, sUN'po <br />STATE OF FLO DA ) <br />COUNTY OF cha <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 waacknowledged before me this b� day of <br />20na, by W ��;FwLegi-d Maxi' [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 />tM WNOUCHMA L*Mm uNH F&K <br />Notary Public <br />aTO <br />State of Florida <br />Comm# HH176908 <br />� Explres 9/20/2025 <br />�Lm &ko, <br />N tary Public — State o Florida <br />Lar k� <br />Print or Type Commissioned Name <br />Personally Known — OR roduced I e�ltification!/ <br />Type of Identification Produced � ���nQmfe)— -' ' 7 �J L9v)j— D <br />DECEMBER28, 2010 <br />