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❑�S�KNY �S1 ��d <br />F <br />u � x <br />F•C r�• FLd*4QOywr <br />OF SUN T <br />STATE OF FLORIDA ) <br />} <br />COUNTY OF 1'111001. r ;i <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: P✓'�iG�{,j }� <br />The foregoing instrument was acknowledged before me this 28th .day of <br />&41S -t 20-21 , by _ C0,44!Z5 /" 1 /Vunc�_ [name <br />of erson], as )4 [type of authority], for <br />Nure;i! cPnsh7�cUr fnc� [name instrument was <br />executed]. I i Notary Public State of Florida <br />AFFIX NOTARY STAMP HERE: <br />Personally Known <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />Ana Lozano <br />I M Commission HH 411897 <br />t AExpires, 6118/2027 <br />of Florida <br />tk , -FI 1819 -1- <br />Print or Type Commissioned Name <br />OR Produced Identification <br />