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STATE OF FLORIDA ) <br />) <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 />COUNTY OF _Leon ____ ) <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. <br />By: <br />Title: _Owner _________ _ <br />:: The foregoing instrument was acknowledged before me this 11..-t� day ofJS, b X'.\A{>.,� , 2 O ?-lq , by � OJ\ Qi:tt:ro W'.\ [name of persn], as Ow (\ty [type of authority], for Q� Lc,..w G.y,� [name of party on behalf of whom instrument was executed]. <br />AFFIX NOTARY STAMP HERE: <br />otary Public -tate of Florida <br />1ani1?"'Jl� ype 6� missioned Name <br />Personally Known x' OR Produced Identification ___ _ Type of Identification Produced _____________ _ <br />DECEMBER 28, 2010 <br />PITTMAN LAW GROUP RFP #26-01-01 33