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STATE OF FLORIDA <br />COUNTY OF gWttlCld <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 />The foregoing instrument <br />2)& , 20Z -'Z, by <br />of person], as <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />By:� <br />Title: <br />w s acknowledged before me this day of <br />[name <br />[type of authority], for <br />[name of party on horn instrument was <br />r1� <br />N tary Public —State of Florida <br />V,P� ANGELA PAULINO <br />� Notary Public - State of Florida r ' <br />V` Commission # HH 233411 <br />�•• My Comm. Expires Feb 27, 2026 <br />Print4 Type Commissioned Name <br />Personally Known OR Pro¢ucec(,�d�ntification <br />Type of Identification Produced I -C— � r <br />DECEMBER28,2010 <br />