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O� M1ON Rt '+`FJO <br />t <br />A <br />V I <br />Pti �r <br />� IIOP MQ` <br />' or purr' <br />STATE OF FLORIDA FL ) <br />COUNTY OF Miami -Dade ) <br />ANTI- KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 0470606 Fax (305) 049 -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: vy President <br />The foregoing instrument was acknowledged before me this day of <br />rk9 , 20_`_, by �� qAR rxcctIE [name <br />of person], as VICES QNJIo -,-"T- [type of authority], for <br />1501-IN#e d aro Es a c 1 } r,N +Ls [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP W :mur4oz <br />DONNA <br />V"l4oTARY PUBLIC <br />STATE OF FLORIDA <br />Comm# EE214792 Expires 71812016 <br />Personally Known OR Produce Identification <br />Type of Identification Produced tAn � : � roc e yr52 . <br />DECEMBER28,2010 7 of 10 <br />