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I <br /> k SVA.�1F! <br /> U ((�� '' ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> • 18070 Collins Avenue <br /> I \'o. 5u <br /> '? '•,o mo .. Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 1 ANTI-KICKBACK AFFIDAVIT <br /> I STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF Orange ) <br /> II, 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 /> Icommission, 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: -a "' Cb-- - C.) "_ 7 <br /> 1 Title: Shareholder <br /> 1 The foregoing instrument was ackngqwl9,4ge4d before. me this 21 day of <br /> neLS),Inn , 20 I5- , by DVn)2il J - LiIC,��—Y(' [name <br /> I of person], as at .a'.,... -.- [type of authority], for <br /> M _a ,_ i,• ) ._ J ►J. ) I name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: <br /> I <br /> Notary P c tate of F rida <br /> s Nota n n, a Florida <br /> IA'ar+ Myycc«nmiS W 9213651 Tiffany S. Wynn <br /> EAmeaa 01/05/1019 <br /> iPrint or Type Commissioned Name <br /> I Personally Known OR Produced Identification <br /> Type of Identification roduced <br /> I <br /> I <br /> I <br /> DECEMBER 28.201 e 7 of 7 <br /> I <br />