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SV��F <br /> /�/ ±' ANTI - KICKBACK <br /> VI lz <br /> 1\ �� City of Sunny Isles Beach <br /> • 18070 Collins Avenue <br /> • i <br /> 0/,U•n o• a Sunny Isles Beath,FL 33160 <br /> a, sus '� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> N'44)nY€_i <br /> STATE OF-fh6 A <br /> Rt0' ��//'' ��) <br /> COUNTY OF,/_'__i� )-C <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: Kathleen M. Bedwell <br /> Title: Executive Director <br /> ® The foregoing instrument w s acknowledged fore me this 3 day of <br /> 20 , by lee4/.M . Wall [name <br /> pf person , as ho& VG PitedJi [type of authority], for <br /> ! <br /> I 1JIL&q/n1&4C [name of party on behalf of whom instrument was <br /> executed]. J <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public — State of-Hui kid AtQQ,btdsrst <br /> Print or Type Commissioned Name <br /> CATHY N.TURNER <br /> ^ ' NOTARY PUBLIC,STATE OF DELAWARE <br /> Personally Known OR Produced Identification IvX� tn�MrvuSSroNEX%ReSAUGUST o,2011 <br /> Type of Identification Produced AIL-..JeJ <br /> • <br /> O[CEM ER 26.2010 7 of 10 <br />