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® SUNNY ISIE <br /> ANTI - KICKBACK <br /> V � <br /> City of Sunny Isles Beach <br /> C <br /> \\ � 18070 Collins Avenue <br /> ® �. '• nowoo Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 0 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> 0 STATE OF FLORIDA ) <br /> ® COUNTY OF Broward <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: I�i ; . cP� <br /> ® , <br /> 0 Title: Managing Partner <br /> 0S <br /> ® The foregoing instrument was acknowledged before me this 30 day of <br /> , 20 /5-, by William G. Benson, C.P.A. [name <br /> ® of person], as ktanaging Partner [type of authority], for <br /> Keefe McCullough [name of party on behalf of whom instrument was <br /> ® executed]. <br /> 0 <br /> ® AFFIX NOTARY STAMP HERE: <br /> 4162 <br /> Notary Public — State of Florida <br /> ® �,,, KAITIJN F.CHUBECK <br /> Wt MY COMMISSION#FF234866 <br /> EXPIRES:MAY 27,2019!-i':n r ��ber-L <br /> ® °Sr Bonded though 1st State Insurance -Print or Type Commissioned Name <br /> 0 <br /> ® Personally Known OR Produced Identification <br /> ® Type of Identification Produced <br /> 0 <br /> 0 <br /> DECEMBER 25.2010 7 of 7 <br />