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SECTION SIX: <br />Contract FormLs <br />'F <br />STATE OF FLORIDA ) <br />COUNTY OF Broward ) <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 />Title: Vice President <br />/' The foregoing instrument was acknowledged before me this I ' t day of <br />Au(nII'S , 201.4 , by Tm -+A LL, -P.E, [name <br />of person], as V( cs� I�rpi.n t [type of authority], for <br />ke tna o; nd 5ck/uA?Fs [name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />WYCOAWISSIONliff 11266S <br />EXPIRES: May 10, 201E <br />z��C.�. '' , __ <br />(Notary Public — State of Florida <br />4c,. I e Wt <br />Print or Type Commissioned Name <br />Personally Known ✓ OR Produced Identification <br />Type of Identification Produced /A <br />Page 73 � KEITH and SCHNARS. P.A. <br />�J' FLORIDA5 gig LDCAL FIRM <br />