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1 <br /> Appendix Ill — Proposal Forms (continued) <br /> 1 <br /> ANTI - KICKBACK <br /> X11 City of Sunny Isles Beady <br /> 18070 Carts e•En e <br /> • Sunry I9es 3ac..,FL 33160 <br /> �..0 Te!e;nare:(3(5)9J]-0515 Fax(305)449-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA <br /> COUNTY OF Miami-Cade ) <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 /> 1 by an officer of the corporation. <br /> By: <br /> Title: Partner <br /> ,L)\ The foregoing instrument acknowledged before me this alga` day of <br /> e-c r)/ J 20/4 by k [name <br /> of person asd-f>/,., [type of authority], for <br /> 6c 4 <br /> 3C ,.wwy .ii [name of party on behalf of whom instrument was <br /> executed]. / <br /> AFFIX NOTARY STAMP HERE: <br /> V{r rp <br /> MY1E19)37Notary to of Florida <br /> ' <br /> WIRES:Noremtal&2019 ,144.1<-1b� Cs�fEGIL) <br /> 41111")" gate)Tlw 94etNcely Serie <br /> Print or Type Commissioned Name <br /> Personally Known 1/ OR Produced Identification <br /> Type of Identification Produced <br /> 1 <br /> 1 <br /> Of ?B.2010 70(7 <br /> 1 <br /> PROPOSAL <br /> 1 GLSC&COMPANY, PLLC RFP # 15-12-01 <br /> ` s -- rr rilirJ pebliv arsnuntont, <br />