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STATE OF FLORIDA ) <br />COUNTY OF M0111 Dacey <br />ANTI -KICKBACK <br />City & 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: 'J4',yC" <br />Title: PUZU, _ <br />The foregoing instrument was acknowledged before me this day of <br />�.,I'.. 20by i), ( f 1 Q WGl [name <br />of person], as [type of authority], for <br />[name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />ik:� <br />Notary Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced 1) IT <br />DECEMBER 28, 2010 <br />rTe 23 a5 02 33 <br />GE <br />ELIZA:State <br />Notary Publiof FloridaClm1ml5Sl24670'nMy <br />Comm. Ear 29, 20253onded <br />through NNotary Assr. <br />ik:� <br />Notary Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced 1) IT <br />DECEMBER 28, 2010 <br />rTe 23 a5 02 33 <br />