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VtaNY IS, <br />09* <br />V _ <br />carr Or sulk <br />STATE OF FLORIDA ) <br />COUNTY OF T2340 ) <br />ANTI—KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33180 <br />Telephone: (305) 947-0808 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: X40", <br />Ge <br />Title: C� <br />The foregoing instrument was acknowledged before me this --ft day of <br />�1�oci v a -- , 20_2±�, by [name <br />of person], I as 0w V.- [type of authority], for <br />G"'CA raCit:+.'r SWL. [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Notary P lie—Sfate of Florida <br />JESUS AOgIEL L0782,nte 01 Flodda <br />r t4otan p utst;r,. S 976754 <br />its �mmias�on# Apt <br />o 11 7,2024 <br />Mya>mm•e'� Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEmsER28,2010 <br />64 Green Facility, Inc, Bid # 24-01-01 <br />200 <br />