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Ni„ <br /><f <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 />STATE OF FLORIDA ) <br />COUNTY OF Seminole <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 />Kurt R. Luman, Jr., P.E. <br />Title: Vice President <br />The foregoing instrument was acknowledged before me this 11 day of <br />August 20 14 by Kurt R. Luman, Jr., P.E. [name <br />of person], as Vice President [type of authority], for <br />CPH, Inc. [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />No ry Public — StatL. . ,IoridSMAASWM <br />MY COMMISSION i EE 047217 <br />EXPIRES: January 2,2015 <br />u'lx n o4P &1dw bhu Buko Not" SaeQs <br />Print or Type Commissioned Name <br />Personally Known X OR Produced Identification <br />Type of Identification Produced <br />OECEU 928.2010 7 Of 7 <br />