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STATE OF FLORIDA ) <br />COUNTY OF ) <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />19070 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 />executed]. <br />AFFIX NOTARY STAMP HERE: <br />By: MWL t�)P( 0\� <br />Title: eLL o <br />( - <br />of <br />v yj v rLname <br />[type of authority], for <br />behalf of whom instrument was <br />blic — State of Florida <br />mmissioned Name <br />Personally Known P,{o d Ic <br />Type of Identification Produced 1 _ ;— �� <br />DECEMBEF128, 2010 <br />